What Does it Mean to Say that Life is Meaningless? A Directional Account

Imagine there’s a chandelier above your head. One of those long, dangly ones with branches of glass hanging down. It’s throwing light all around the room. Now imagine that you look at the base of the chandelier and realise that it’s not, actually, attached to the ceiling. It’s just hanging there, suspended in space. Right above your head.

Hold that image.

So this blog is about something I’ve struggled with for years and years and years and have found a way of conceptualising it that makes sense for me. It’s not a particularly upbeat or reassuring blog, so if you’re struggling with things and feeling low at the moment you may want to stop reading now.

The blog is about the notion that life is meaningless, and what that actually means. It’s a key tenet of a lot existential thought (though by no means all of it). Camus, for instance, writes about the ‘absurdity’ of existence; and Yalom, in his classic text on existential therapy, describes various therapeutic strategies that can be used to help clients address profound feelings of meaninglessness in life. But what does that ‘meaninglessness’ actually mean?

Here’s one way of describing it. The term ‘meaning’ can mean many different things. But when we speak about the ‘meaning’—or ‘meaninglessness’—of life, what we are asking about is its significance: the reason why it is there. It’s like, ‘What’s the meaning of work?’ or ‘What’s the meaning of going out every Friday night?’ We’re asking what those things are trying to achieve. Why we’re doing them: for instance, ‘to make money’, or ‘to make friends’.

From a ‘directional’ standpoint, this is about going up to a ‘higher order of direction’. That sounds horribly jargonistic but let me explain. It’s based on the directional framework that I’ve recently outlined in my book, ‘Integrating counselling and psychotherapy: Directionality, synergy, and social justice’ (Sage, 2019), which draws on the work of highly-respected theorists like Powers and Grawe.

So the directional framework says that we do things for reasons (i.e., we have directions in life), and we can trace those reasons up and up and up to higher and higher orders of directions. So, for instance, we go to work to make money, and we make money because we want to have leisure time, and we want to have leisure time because we want to have pleasure. And we can also trace those directions downwards, and we do that by asking ‘how’? So, for instance, How do we get to work? We did training, and we got trained by turning up at college every day, etc. And then we could go back up the hierarchy from turning up at college to training to working to money to leisure to pleasure. From this standpoint, everything has a reason for it, and everything has a way that it’s done (right down to the very micro motor movements that help us make things happen in our lives). And we can think of the whole thing like that dangly chandelier, with a few highest-order directions (like pleasure, or love, or actualisation of potential) right at the top, and then branching down to an increasing number of lower-order directions as the means to achieve them.

You can probably see where I’m going with this. The thing is, we can go up and up and up to highest-order directions like pleasure but then, when we ask, ‘What is the meaning of pleasure?’ we’re stuck really. There just isn’t any answer. Or ‘Why actualisation of potential?’ or ‘Why spirituality?’ They’re there, but there’s no real way of going above them to something higher order. One option might be to say that these directions contribute to a wider social direction, like global harmony or planetary healing but still, then, so what? What does that lead up to. Essentially, there’s nothing ‘fixed’ up there. Nothing solid that we can hang the whole chandelier on. Nothing that can help us make sense of our lives and our worlds. And that’s why, sometimes, standing underneath it, we can feel that sense of dread that everything is about to come crashing down. That everything that shines light on everything is just an illusion and there no real meaning or purpose to any of it at all. For Heidegger, these were moments of genuine insight and authenticity. When we see the world for exactly what it is. Baseless. Unattached. Dangling.

Of course, most of the time we’re not that focused on that chandelier. We’ve got things to do, getting on with our lives. And anyway, like Yalom’s Staring at the sun, there’s limits to how much we can look into that direct light. Indeed, some people have probably never looked up at all. Or looked up and never seen that that base is unattached. But for others of us, even if we’re not looking up, there’s some constant awareness—sometimes better, sometimes worse—that something isn’t quite right. A sense of uncanniness. Unease. And for others of us, it’s like we’ve been born staring up and just can’t pull our eyes away. Once you’ve seen how unattached things are, it’s something you can never forget.

Camus talks about building castles in the desert. We can create, and commit to, local meanings, even if there’s nothing ultimate solid that they lead up to. Similarly, Yalom writes about re-engagement with the world. But, personally, I think there’s just no way out of recognising that life is, ultimately, unattached to any fundamental meaning, and that’s just a really painful, dreadful ‘truth’ that many of have to live with. Indeed, I think it blasts a fairly sizeable hole into all of our therapeutic practices, including existentialism and pluralism, because it means that a lot of our anxiety and sadness just can’t be ‘therapised’ away. However much CBT someone has, or psychoanalytic psychotherapy, the reality is that many of us live in the deeply unsettling, deeply ‘rational’ knowledge that there is no real, fundamental reason for anything we do.

At best, perhaps, talking about these things can help us feel that, at least, we are not alone with it—that’s there’s others there standing, staring up and feeling unsettled too. So if you’ve ever wondered what it’s all about and felt despair at the apparent purposelessness of existence, at least know that I’m there as well, and so is Albert Camus, and perhaps many others: great and not-so-great minds alike. And as Viktor Frankl put it, the great meaning-centred therapist, it can ‘never be taken as a manifestation of morbidity or abnormality’ to challenge the meaning of life. Rather, ‘it is the truest expression of the state of being human, the mark of the most human nature in man.’

Why I Love Qualitative Research

I’ve just come off an hour’s Skype on a qualitative research project. We’re looking at clients’ experiences of preference accommodation. Do clients want therapists to ask them about their preferences? Do they find it helpful having them accommodated? Do clients preferences change over the course of therapy? We’re engaging in a research process called Consensual Qualitative Research (CQR), and have the privilege of having one of the developers, Sarah Knox, on our research team. It was an hour, also with Gina di Malta and Hanne Oddli, going over the first part of an interview transcript and trying to put into ‘domains’ what the participant was saying about preference accommodation. Were they saying that their preferences had come from their previous therapy, or were they saying that the therapist just intuitively knew what they wanted? Back and forward: dialoguing and disagreeing and trying to make sense of things. CQR is a fascinating qualitative method where you work together on the analysis as a team. It really gets to the heart of qualitative research: working to make sense of what people are saying and experiencing in their lives.

Working on this project has really reminded me of the extraordinary things that can be achieved through qualitative research. Of course, being a pluralist, I love quantitative research too, but there’s something about the qualitative process that gets to the depth of things in a way that numbers never really can. When you’re interviewing someone, when you’re asking them about their lives and perceptions, you’re getting straight into the process by which someone comes to do the things that they do. And what things mean for them. You can look at numbers, and you can say that, for instance, ‘School counselling leads to reductions in distress’ but you don’t really know why. It’s like looking at the world through a mesh. But with qualitative research, you can really ask people about things, and then ask them again. And ask them in different ways that mean that you can build up such a rich picture of what’s going on.

Interviewer: What was it like seeing the school counsellor?

Young person: Well I- I really liked how she talked to me about things.

Interviewer: So you liked talking about things. Can you say more?

Young person: It was, I felt that the more I talked about things the more I kind of felt relieved. Less stressed.

Interviewer: So the stress came off as you talked. Is that right?

Young person: Yes, I felt a weight coming off. I talked about things and, as she listened, I felt at least someone else knew what was going on. I wasn’t alone. And I got some ideas about how to talk to my mum…

Of course, qualitative research doesn’t do everything. It’s not great if you want to compare between groups, and it’s hard to generalise too widely from it. But generalisation is based on the assumption that everyone acts according to the same laws and, actually, what qualitative research helps you to see is just how different everyone is. One participant says that they really loved going to see the school counsellor. Another says that they hated it. Taken quantitatively, you can end up averaging these two things out so that, on average, people feel fairly neutral about seeing a school counsellor; but actually that’s not the reality at all. The reality is that some loved it and some hated it. And qualitative research can really help us to hold on to, and prize, those differences.

It’s for reasons like these that so many counsellors, psychotherapists, and counselling psychologists would rather be doing qualitative research than quantitative. It’s not a million miles from being with a client: listening, understanding, deepening an empathic attunement with another’s world. A key difference though is that we’re also taking that out of the therapy room and telling others about it: so that, for instance, clinicians can use that knowledge to inform and develop their practice. That’s why one thing I am really passionate about is trying, wherever possible and ethical, to do qualitative research with clients rather than therapists. I know, I know… it’s more difficult often to find clients to do research with, and there’s additional ethical considerations. But when you’re talking to clients about what they feel about therapy, when you’re asking them what was helpful and not helpful and then bringing it all together into a coherent whole, there’s something amazing you’re learning about what we do. It’s ‘straight from the horses mouth’: deeply, profoundly affecting how we can think about the people sitting opposite us.

Just today we published a study on clients’ experiences of working with goals. Again, in many ways, it was a really simple study: we talked to clients about how they felt about working with goals in therapy. Yet I feel like I learnt so, so much to help me in my clinical work. For instance, I’m a real advocate of goal-oriented practices, but clients were also saying that, in some instances, goal setting could feel premature. They really didn’t know what they wanted. And there was some clients who felt it was mechanistic, and demotivating at times. Sure, you can say, ‘Well, I could have told you that without interviewing 22 clients,’ but then there were also some very positive things clients said about working with goals, like they could bring focus and help them progress forward step-by-step. So qualitative research, particularly with clients, can help us out of rigid positions of ‘clients want this’ or ‘clients want that’ towards an appreciation of the complex, heterogeneous, and multifacted world of clients’ experiences of therapy. A few years back, John McLeod and I published a protocol on conducting qualitative research into clients’ experiences of what is helpful in therapy, and I think it’s still a very useful framework for conducting research that can really contribute to the development of our knowledge and practice (see here).

I wish qualitative research played more of a role in informing clinical guidelines and policy. But I think it’s up to us involved in it to try and sketch out what that might be. The great thing about randomised clinical trials is that they give very clear results, and you can bring them together to produce specific and definitive guidelines for policy and practice. How do you do that with qualitative research? I am sure you can, but we need to work out how. In the meantime, though, I hope that more of us can get more time really talking to clients about what therapy is like, and learning more and more about what’s working and what’s not. It’ll never give us definitive answers, but it’ll help us build up a richer and richer picture of how, where, and why we can be most helpful in our work.

Person-Centred Therapy: Myths and Realities

Myth: Person-centred therapy is ‘just the basics’—everyone does it, it’s just that some therapists go on to do more advanced things, like psychodynamic therapy or cognitive-behavioural therapy.

Reality: Developing one’s capacity to engage with another human being at a level of interpersonal depth is a life-time’s achievement. Few ‘purely’ person-centred therapists, even after many years, would claim that they have reached the end of that road, so the chances of getting there after a few years’ study are pretty remote. Moreover, skills and ideas from other therapeutic approaches—like psychodynamic therapy or cognitive-behavioural therapy—can’t just be ‘dumped’ on top of a person-centred foundation: they need careful integration. Finally, whilst it’s true that the skills and ideas associated with person-centred therapy can be taught at a fairly basic and accessible level, the roots of the approach dig down into some far more complex ideas. Understanding the person-centred approach, then, can involve engaging with the ideas of such philosophers as Martin Buber and Edmund Husserl, as well as the complex psychological processes that Carl Rogers, the founder of the approach, outlined in his theory of therapy, personality and interpersonal relationships (see here).

 

Myth: There’s no evidence that person-centred therapy works.

Reality: Rogers was one of the first people to systematically study the therapeutic process, and his hypotheses about the necessary and sufficient conditions for therapeutic personality change were firmly grounded in the empirical data. Today, more than ever, there is compelling evidence that person-centred therapy is effective with a whole host of psychological difficulties (see Elliott et al, here); and that relational factors—such as empathy, unconditional positive regard and congruence—are central to the process of therapeutic change (see here). (For more discussion of the evidence base, see my previous blog here).

 

Myth: Person-Centred therapy doesn’t have a model of psychopathology.

Reality: It’s certainly true that person-centred therapists try to see their clients, first and foremost, as unique individuals, and not as representatives of a particular label; and it’s also true to say that person-centred therapists are as interested in their clients’ potentialities as they are in their problems. But, in recent years, numerous therapists within the person-centred field have attempted to understand severe psychological distress from a humanistic perspective (see here). For instance, there is the work of Margaret Warner on ‘difficult’ and ‘fragile’ psychological processes; Elke Lambers’ accounts of psychosis, neurosis, and personality disorders; and Gary Prouty’s work on ‘pre-therapy’ with schizophrenic and other ‘contact-impaired’ clients.

 

Myth: Person-centred therapy is one, particular approach to therapy.

Reality: Both within and outside of the person-centred field, many people do not realise the sheer scope of, and diversity within, this approach. At one end of the spectrum, for instance, are those ‘classical client-centred therapists’ who put great emphasis on not directing the client in any way; whilst there are others who put much more emphasis on entering into a dialogue with the client, and acknowledging that the client may be influenced by the therapist (and vice versa) in numerous ways. Then there are those in the closely related field of the ‘process-experiential therapies’, who will actively invite their clients to process their experiences in particular ways (whilst not attempting to direct the content of those experiences). There are also arts-based approaches to person-centred therapy, the aforementioned person-centred approaches to working with ‘contact-impaired’ clients, and approaches which are fundamentally integrative/pluralistic in nature. In fact, these days, many people talk about the ‘family’ of person-centred and experiential therapies, or of the different ‘tribes’ of person-centred therapy, to highlight the diversity of ideas and practices within this field (for a great introduction to the many different tribes, see here).

 

Myth: Person-centred therapists mustn’t ask questions.

Reality: Most person-centred therapists are keen for their clients to take a lead in the therapeutic work, and, for this reason, they will avoid bombarding them with questions. But there are no ‘mustn’t’s, ‘must’s, ‘don’t’s or ‘should’s about person-centred practice, because person-centred therapy is not about behaving in a particular way with clients, but about being a particular type of person with another human being. So, for instance, in attempting to establish an empathic understanding of a client, a person-centred therapist may ask them a question; or they may ask them a question as an expression of their interest in that client’s experiences.

 

Myth: It’s not person-centred to challenge clients.

Reality: Person-centred therapists are careful to avoid criticising clients and undermining their sense of self-worth, but it can also be one of the most challenging and direct forms of therapy. In being congruent with a client, for instance, a person-centred therapist may really let that client know how hurt or angry he or she feels towards him or her; or, in being unconditionally accepting of a client, a person-centred therapist may really challenge a client’s feelings of low self worth.

 

Myth: Being a person-centred therapist means having to like your clients and everything that they do.

Reality: At the heart of a person-centred approach to therapy is the distinction between what a person experiences and the way in which they behave. So, whilst a person-centred therapist would want to unconditionally value everything that their client experiences—whether it’s love, jealousy or rage—this doesn’t mean that they would unconditionally value every way in which their clients behave. If a client physically threatened another person, for instance, a person-centred therapist might experience feelings of annoyance or anger, and might well communicate to their client that they were doing so. What they would also try and do, though, is to communicate to that client that they also valued the feelings and experiences that underlay those behaviours, and their belief that the client had the potentiality to find more constructive ways of expressing these feelings.

[image, Kendl123, Creative Commons Attribution-Share Alike 3.0 Unported license]

Is Person-Centred Therapy Effective? The Facts

Are you sick and tired of people telling you that ‘person-centred therapy doesn’t work’’? Does your manager try and convince you that there’s no evidence for the approach? Would you like to scream at the next person who tells you that person centred therapy is ‘just the basics’ and that ‘everyone does it all anyway’? If so, here’s ten facts about the evidence base for person-centred therapy that might just keep you sane… and everyone else that better bit informed.

  1. Humanistic and experiential therapies, of which person-centred approaches form a substantial part, bring about large and significant reductions in psychological distress (see Elliott et al.’s 2013 comprehensive meta-analysis for the definitive review).

  2. The effects of humanistic and experiential therapies are similar, on average, to other therapies—including CBT. This is particular true when the allegiance of the researchers is taken into account (again, see Elliott et al., 2013). It’s also true whether the effects from different studies are compared against each other, or whether two therapies are directly compared together.

  3. Studies which compare the outcomes of person-centred therapy in real world settings (e.g., IAPT) again show that these are very similar to CBT and, indeed, may be achieved in a shorter period of time (see Pybis et al., 2017).

  4. There’s no consistent evidence that CBT or psychodynamic therapies have longer lasting effects than person-centred therapy, or that they ‘work’ more quickly.

  5. It’s the dodo bird, stupid (though maybe don’t say the ‘stupid’ bit to your manager!). Again and again, what the research shows is that ‘everyone has won and all must have prizes’—all therapies, overall, do about as well as each other.

  6. There is an overwhelming body of data to show that Rogers’s three ‘core conditions’—empathy, unconditional positive regard, and congruence—are all associated with positive outcomes (see Norcross and Lambert, 2019).

  7. Studies which ask clients what they found helpful in therapy (whether CBT, psychodynamic, or humanistic) show, again and again, that much of what they most value is relational qualities closely associated with a person-centred approach: e.g., therapist warmth, caring, and trustworthiness (see here for one very recent example).

  8. Consistent with person-centred theory, research shows that, by far, the largest contribution to therapeutic outcomes comes from clients: their levels of motivation, involvement, engagement. It’s clients that make therapy work, not therapists (see Bohart and Wade, 2013).

  9. Person-centred counselling with children, and with young people, also shows good outcomes, at a level consistent with other therapeutic orientations.

  10. Even if there are small differences in the overall effectiveness of different orientations, this doesn’t take into account the fact that different clients do better or worse in different therapies (and at different points in time). Research shows, for instance, that clients who are more independent, who deal with issues in a more ‘internal’ way, and who particularly want space to talk are likely to do very well in a person-centred approach (see my Facts are Friendly).

The bottom line… be proud of being a person-centred practitioner and all the evidence behind our approach. But be informed as well (see here for a good overview of all the evidence). There’s every reason to challenge someone who belittles the evidence base for person-centred therapy, but you need to know your research and what it all means.

The Inventory of Preferences (C-NIP): A User's Guide

John Norcross and I developed the Cooper-Norcross Inventory of Preferences (C-NIP) back in 2015 as a means of helping clients to articulate their preferences in therapy. The aim was to develop a tool that could help shape the therapy as close as possible to the client’s individual wants and needs. Since we developed it, it’s been used in services in the UK and translated into over 10 different languages.

For the first time now, John, Gina Di Malta, and I have put together some instructions for use. These are downloadable in PDF format, along with the C-NIP form, and reprinted below. A free-to-use digital tool for completing the C-NIP with clients has now also been made available here. This is a great new site (if I say so myself) in which clients are asked about their therapy preferences, and then the site produces a report indicating where any strong preferences lay.

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Background

Research suggests that eliciting—and accommodating—clients’ psychotherapy preferences make valuable contribution to outcomes. It is associated with large reductions in drop- out rates and medium improvements in clinical change (1,2).

The Inventory of Psychotherapy Preferences (C-NIP) was developed by Drs. Mick Cooper (University of Roehampton) and John Norcross (University of Scranton) in 2015 (3). The 4 scales were based on factor analysis and normed on both United Kingdom and United States samples. The measure was designed for use in clinical practice as a means of facilitating discussion with clients about their desired style of therapeutic engagement. It can also be used in supervision, research, and training.

About the C-NIP

The C-NIP can be used in an initial assessment or early session of psychotherapy or counselling to facilitate an initial dialogue with clients about their therapy preferences. It can also be used in farther sessions at regular intervals (for instance, session 5 and session 10) and is particularly useful during a review session or routine outcome monitoring.

The C-NIP consists of two parts. The first part invites clients to indicate their preferences for how they would like a psychotherapist or counsellor to work with them on 18 items. The items are grouped into 4 bipolar scales: Therapist Directiveness vs. Client Directiveness, Emotional Intensity vs. Emotional Reserve, Past Orientation vs Present Orientation, and Warm Support vs. Focused Challenge. At the end of each scale is a scoring key, which calculates strong preferences in either direction.

The second part asks multiple open-ended questions about client preferences. For instance, clients are asked if they have strong preferences for the number of therapy sessions, therapy format/modality, or anything they would particularly dislike.

Completion and scoring of the C-NIP typically takes 5 minutes. The length of the subsequent discussion and treatment planning varies considerably.

The C-NIP measure is free to use and is licensed under the Creative Commons Attribution-NoDerivatives 4.0 International licence. No permission is required. However, you are asked not to alter the form and to use the latest version (currently 1.1). The C-NIP developers are pleased to hear about your experiences using it; both good and bad.

Several studies provide evidence of the instrument’s reliability and clinical validity (3,4). For more information, see (3).  

Completing the C-NIP

Administration formats.

The C-NIP can be completed online or as a paper copy. Clients can complete the measure on a desktop, laptop, handheld device, or on their own phone. The site will take the client through a series of questions, automatically scores their responses, and produce a brief report of the client’s scores. This report serves the basis for the subsequent dialogue with the therapist (see below).

The C-NIP can also be administered as a paper copy and scored by hand. Clients are handed the form and asked to circle one response for the 18 items. They are told to ignore, for now, the coloured scoring boxes.  Clients are asked to check or circle any of the open-ended additional preferences at the end of the measure. When completed, the clinician scores the 4 scales and reviews the checked or circled open-ended preferences.

The initial invitation.

Clients can be verbally invited to complete the C-NIP in a variety of ways. For 4 examples:

  • I have been conducting and researching psychotherapy for XX years, and we have learned the importance of tailoring or personalizing psychotherapy specifically to you. Here is a brief instrument that can help us do just that. 

  • We really want counselling to be as suited as possible to what you want. So we’d be grateful if you could spend a few minutes completing this questionnaire to tell us what that is.

  • Let’s determine your strong  preferences for this therapy. Would you kindly take a few minutes to complete this form?

  • Research attests that psychotherapy works best when it matches clients’ preferences. Here’s a brief, efficient way that we can begin that discussion.

Consistent with the C-NIP’s emphasis on honouring client preferences, we do not require clients to complete the C-NIP. If a client indicates that they are not willing, interested, or ready to complete the form, then we respect that decision. The form can either be completed later in the psychotherapy/ counselling or not at all.

Scoring.

Scoring the C-NIP is straightforward. Sum/total the 5 items constituting each scale (3 items for the past/present orientation scale). Then determine whether that scale score indicates a strong preference in either direction, or no strong preference. Scores which are marked with a minus should be subtracted from the total. For instance, if a client scores 3, 0, and -2, the total would be 1; if they score -2, -3 and 2, the total would be -3. For each scale, circle in the coloured scoring box whether they have indicated a strong preference (in either direction) or no strong preference.

The C-NIP was normed so that approximately a quarter of client scores will fall into a strong preference on one side, another quarter into a strong preference on the other side of the scale, and the remaining one-half of scores into the average or no strong preference range.

Discussing the Scores

The subsequent dialogue with clients about any identified strong preferences is generally the most important part of the C-NIP process. Remember that the C-NIP scores are the starting point for a genuine exchange about how clients can get the most out of their psychotherapy.

  • When strong preferences are identified, the clinician can reflect this back to the client and inquire further into its meaning. For instance: I can see here that you desire quite an emotionally intense therapy. Can you say more about that?

  • Your responses suggest that you want me to challenge you. Is that right? What sort of challenge do you think might be helpful?

  • You’re keen to meet every two weeks. Do you have a sense of how that would be helpful to you?

It may also prove helpful to inquire into the origins of clients’ preferences. This typically generates more context and meaning to their treatment desires. For instance:

 Clinician: You indicated here that you want quite a directive approach, with lots of guidance and structure. Do you have a sense of why that is?

Client:      Yes. The last counsellor I had was really nice but she didn’t say too much, and I found it all a bit… aimless and meandering. So I think this time I’d like someone who focused me more.

Clinician: So it’s about, maybe, having someone to focus you. Is that right? [Client: Mm]. For instance, would it be helpful if I asked you at the start of each session what you’d like to work on?

 Of course, there may be times when it is appropriate for clinicians to bring in their own knowledge and experience to the exchange. For example, if a client has been saying she frequently defers responsibility to others, and then on the C-NIP indicates that she has a strong preference for therapist directiveness, the therapist may inquire about potential parallels here. For instance:

 Clinican: I can see here that you are asking for a directive approach.

Client: Yes, I feel like I just don’t know my own mind.

Clinician: OK. I’m aware that you were saying earlier about being really deferential to others and that’s a real problem for you. I’m OK about being quite directive here; at the same time, I’m wondering if that’s necessarily the best thing for you. Do you know what I mean? I wonder if it’s going to end up being like the thing you say is really unhelpful.

Client: Uh… I– I get so lost. Particularly when I feel under pressure.

Clinician: I totally get that. Maybe there’ll be something here about feeling out your own authority. Making, taking more decisions by yourself. And that might include here in therapy too.

 On occasion, the clinician may also bring in research evidence. For instance, when clients indicate a strong preference for emotional intensity, then the psychotherapist may note that, indeed, emotional processing tends to be associated with improved outcomes (5, 6).

 This discussion presents a valuable opportunity, particularly during an assessment session, for clinicians to indicate if they believe, or do not believe, that they can accommodate the client’s strong preferences. When a client expresses a strong preference for therapist directiveness, for example, and the counsellor is committed to classical person-centred therapy, the clinician might say something like:  

I can see you strongly desire a psychotherapist who is going to structure and lead. That’s not what I offer in my practice. My approach tends to be much more about allowing the client to take the lead. Is this something you would like to try, or should we talk about other options that better suit you?

 It is essential that the therapist does not convey judgement to the client’s therapeutic preferences. The client should feel that their preferences are valued, whatever they indicate.

Using the C-NIP in Supervision

The client’s C-NIP scores can be brought in to supervision to inform a discussion about treatment planning and selection—the best way of working with that particular client. Although patients’ preferences represent a single consideration, an awareness of what the client wants can provide valuable insights into the best way forward. For instance:

Clinician: I think, with Jasmine, she’s finding it hard to connect with her emotions and a lot of what we do feels very ‘heady.’

Supervisor: Mm. Any sense of what might help her connect more emotionally?

Clinician: I did think about two chair work. Just– I’m not sure whether she’d go for that or not.

Supervisor: What did she put on her C-NIP about emotional intensity?

Clinician: [Checks C-NIP]. Yes, she did say she wanted something emotionally intense.

Supervisor: So she’s flagging up that that is something she might be up for.

 

Frequently Asked Questions

Do I have to do whatever a client asks on the C-NIP?

Definitely not. As indicated above, the C-NIP serves as the basis for a dialogue, not as a set of commands. So if a client asks for things you can’t do, don’t want to do, or don’t believe would be helpful, that all needs discussing.

 What if a client has no strong preferences?

That may often be the case, particularly if the client has not had counselling/psychotherapy before. It is something that can be fed back to the client and discussed (without conveying that they should or must have strong preferences). For instance, a psychotherapist might say, “I noticed that you didn’t have any strong preferences for therapy at this time, is that about right?”

The absence of strong initial preferences can denote many impressions, from clinical inexperience, to an unassertive interpersonal style, to cultural proscriptions, and the like. In many cases, it may reflect the fact that the client is intent on ‘getting on’ with psychotherapy and doesn’t feel too strongly about how that’s done (provided it works). In that case, prolonging a discussion about patient preferences may prove unhelpful and, paradoxically, against what the client wants!

What if a client doesn’t know what he or she prefers in psychotherapy?

That’s fine, particularly among those new to psychotherapy. Again, clients should not be pressured into stating preferences if they are not ready or real. After a few sessions, many clients will determine what works and what does not work for them. Thus, we recommend periodically returning to assessing preferences.  

My client says that they want both of the things at the different ends of the dimensions.

As the C-NIP instructions specify, when clients hold equal or both preferences, they should circle 0. That indicates that there is not a strong preference in one direction or the other.  

Why do I need to ask explicitly? Isn’t it better to trust my intuitive sense of what a client’s want?

Probably not. Clinicians no doubt pick up a lot from clients, but research consistently demonstrates that psychotherapists who intuit or assume their clients’ treatment preferences, experiences, and outcomes are frequently incorrect (7, 8). There may be a particular danger that we project or generalize onto our clients our own preferences for therapy; and research shows that what mental health professionals desire, as clients, can be very different from what lay clients prefer (4). 

But surely I can just talk about it with my clients? Why use a form?

Talking in session about preferences is fine; indeed, the overarching purpose of the C-NIP is to stimulate such discussions. Like many forms of clinical assessment, using a more comprehensive, standardized instrument with norms probably proves superior to talk alone. Clinical experience and research studies also attest that some clients also find it easier to write than to tell it directly. 

How do clients respond to taking the C-NIP?

In a study of clients’ experiences of using the C-NIP, 10 of 15 clients (67%) described helpful aspects of using the measure. They said that it helped to focus the therapy, facilitated communication with their clinician supported the personalising of treatment, and that allowed them to express themselves. Three of the 15 clients (20%) gave more mixed responses; for instance, ‘I found it OK.’ Five clients (33%) also highlighted unhelpful elements; in particular, that it was difficulty to record preferences because they didn’t know what their preferences were.  

On a 1 (very unhelpful) to 5 (very helpful) scale, the clients gave the C-NIP an average score of 3.8. This suggests that typically clients find the C-NIP helpful, but there are some clients who do not. As indicated above, therefore, clients should be invited to use the measure, rather than instructed to. Care is particularly needed with clients who are new to psychotherapy.  

And what about therapists?

In an interview study on an earlier version of this measure, the Therapy Personalisation Form (9), we found that clinicians were generally positive about its clinical utility. They thought that it was a helpful means of assessing what clients wanted from therapy such that it could be tailored accordingly, and could also serve as valuable sources of reflection and learning about their own practices. In addition, therapist believed that the measure was empowering for clients and helped to move the therapeutic relationship forward. In terms of limitations, they thought that the form could lead to increased therapist self-criticism and over-moulding to the clients’ wishes. 

Is the measure valid and reliable in psychometric terms?

In our original study, we showed adequate levels of internal reliability for the 4 C-NIP scales (3). Subsequent research has suggested that the internal reliability may be weaker than we originally found (4). We are currently examining means to enhance the reliability of the scales while preserving the small number of items.

 In future research, we will also assess the patient utility and predictive validity of the measure. At the same time, remember that the C-NIP has primarily been developed as a means of supporting dialogue on patient preferences, rather than as a definitive measure of wants. As such, we accord primary importance to the clinical utility of the inventory.  

Why doesn’t the C-NIP ask about things that a lot of my clients want, like empathy and acceptance?

Exactly. We know that nearly all clients want to be understood, valued, and not judged. Hence, we did not believe it would prove particularly informative to ask those questions.

 Instead, we developed the scales by reviewing the responsiveness research and by asking therapists about practices that they would be willing to vary (9, 10): that is, when knowing patient preferences could make a genuine difference in clinician practices and psychotherapy success.

References

1.     Swift JK, Callahan JL, Cooper M, Parkin SR. The impact of accommodation client preferences in psychotherapy: A meta-analysis. Journal of Clinical Psychology. 2018;74(11):1924-37.

2.     Lindhiem, O., Bennett, C. B., Trentacosta, C. J., & McLear, C. (2014). Client preferences affect treatment satisfaction, completion, and clinical outcome: A meta-analysis. Clinical Psychology Review, 34(6), 506-517. doi: 10.1016/j.cpr.2014.06.0023.

3.     Cooper M., Norcross J. C. A Brief, Multidimensional Measure of Clients' Therapy Preferences: The Cooper-Norcross Inventory of Preferences (C-NIP). International Journal of Clinical and Health Psychology. 2016;16(1):87-98.

4.     Cooper M., Norcross J. C., Raymond-Barker B., Hogan T. P. Psychotherapy preferences of laypersons and mental health professionals: Whose therapy is it? Psychotherapy. 2019.

5.     Pascual-Leone A., Paivio S., Harrington S. Emotion in psychotherapy: An experiential-humanistic perspective. In: Cain D, Keenan K, Rubin S, editors. Humanistic psychotherapies. 2nd ed. Washington: APA; 2016. p. 147-81.

6.     Peluso, P. R., & Freund, R. R. (2018). Therapist and client emotional expression and psychotherapy outcomes: A meta-analysis. Psychotherapy, 55(4), 461.

7.     Cooper M. Essential Research Findings in Counselling and Psychotherapy: The Facts are Friendly. London: Sage; 2008.

8.     Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110, (2), 639-644..    

9.     Bowens M., & Cooper M. Development of a client feedback tool: a qualitative study of therapists’ experiences of using the Therapy Personalisation Forms. European Journal of Psychotherapy and Counselling. 2012;14:47-62.

10. Norcross, J. C., & Wampold, B. E. (2019). (Eds.). Psychotherapy relationships that work. Volume 2: Evidence-based responsiveness (3rd ed.). New York: Oxford University Press.

Study Skills for Counselling and Psychotherapy Research: Some Pointers

If you’re studying on a counselling, psychotherapy, or counselling psychology course, and want some guidance on writing and the research element of your programme, these blogs may be of help.

All the things I hate about watching myself do counselling practice (and a few I can just about bear)

I recently posted a video of myself demonstrating some counselling skills. I always think there’s a dearth of videos out there demonstrating real counselling practice, so I wanted to post something of what it can really look like (even if it was with an actor). Problem is, reviewing it, I had to watch myself a few times, and like most of us it was a pretty unbearable experience:

  1. I’m wearing a winter jacket when I open the door inside the house. Doh!

  2. Why do I always look so serious? I look like I’m frowning, or sitting on spike. Jeez, lighten up!

  3. ‘It sounds like…’ ‘It sounds like…’ It sounds like I’ve got about four phrases I repeat over and over again.

  4. Profile view definitely not my best angle.

  5. ‘So…’ Is it possible for me to start a sentence without ‘so’?

  6. So can I ever actually finish a sentence without changing tack half way through.

  7. It’s a bit cognitive, isn’t it. I wish I could have given more space for feelings to emerge, or find ways of helping the client go deeper into his emotions.

  8. Stomach. I was pretty chubby as a kid, and still get shudders at the sight of it.

  9. I can’t even get my pronouns right on the captions: ‘Rob’… ‘they’re…’ ???

  10. ‘It feels like…’ another stock phrase I just seem to repeat incessantly.

  11. Is it too meandering? Or perhaps not meandering enough?

  12. I’ve got so many cables behind me. Looks like I’m sitting in an electric chair.

And a few things I do quite like:

  1. Black polo shirt.

  2. I smile sometimes.

  3. I think I’m listening, pretty intensely, and conveying that understanding back.

  4. I guess a few of the summaries draw together things pretty well.

  5. Nice watch. I never wear a watch, just for this video.

  6. Bringing it into the ‘here and now’ [26.02]

  7. My silver chain. Bought that for myself a few years ago and stopped wearing it. Shiny.

  8. We get somewhere in the sessions. I think. It’s only a demonstration, but does illustrate a few things that seem to be helpful in therapy.

Having said that, if there’s one thing more depressing than seeing myself on video, it’s seeing how narcissistic and superficial my comments on seeing myself on video are!

Anyhow, if you’re on a training counselling or psychotherapy course, and cringing as you listen to—or watch—yourself for practice recordings, it may be reassuring to know you are definitely not alone.

What do clients want from therapy (and is it what person-centred therapists might want them to want)?

In a research paper published today (see here for journal version, and here for author final version), we found that a majority of clients wanted a more directive approach to therapy. Our data shows, for instance, that over 70% of clients wanted their therapist to focus on specific goals in therapy, to give structure to the therapy, and to take the lead. Clients expressed a particularly strong preference for therapists to teach them skills to deal with their problems. By contrast, only around 15% of clients wanted a more non-directive approach.

What we also did in our paper was to compare these preferences against therapists’ preferences, themselves. Not surprisingly, perhaps, we found that counsellors and psychotherapists—mainly of a person-centred orientation—wanted a lot less direction. So if we’ve used our own preferences as a guide to what clients are likely to want, it may come as something of a shock to see that, in fact, clients tend to want a lot more structure and leading. But that’s what we found, in two pretty rigorous surveys, and it’s matched by previous findings in the field (see, for instance, here).

These findings may be pretty challenging to those of us, from person-centred, humanistic, and relational orientations, that tend to work in more non-directive and unstructured ways. It suggests that what clients want is sometimes (perhaps often) different from what we tend to offer.

We could try and dismiss these findings by arguing that what clients want is not necessarily what they need. And, indeed, there’s good evidence that people don’t always know what is best for themselves (see, for instance, here). Two problems though. First, the evidence shows that there is quite a good association between what clients say they want from therapy, and how well they end up doing in it (see, for instance, here). So clients’ explicitly-stated preferences do indicate, on average, what works better for them, and also the kind of therapy that they are more likely to stick with. Second, if we start saying that clients don’t really know what they need (and we do), then we’re moving dangerously close to an ‘expert-driven’ perspective which holds that, as therapists, we know what’s best for clients. Not a good place for person-centred therapists to find themselves at!

Maybe it’s a case that clients’ preferences change over time. That is, they start off wanting more therapist direction but, once they get into therapy, they get more used to taking control for themselves. That may also be true in certain instances; but our data suggests that, across therapy, clients’ preferences don’t change too much. Certainly, in my own experience of using a preference inventory, I’ve found that what clients want stay pretty consistent. That is, at the start of therapy, clients are often saying things like, ‘Mick, I’d like this therapy to be fairly task-oriented,’ and after a few sessions they are saying, ‘So come on, when are we going to start on tasks!’

Perhaps clients’ desires for goals, tasks, and CBT is a consequence of neoliberalism, with the promise of an easy fix around every corner: someone who can always sort you out. Maybe. But, in my experience, when clients are asked why they want direction they come out with pretty cogent rationales: for instance, ‘Goals give me a sense of what I can focus on,’ or ‘I’d like to see things from a different perspective.’ And it’s a bit patronising, too, to assume that, because clients may want things different from us, it’s because they’ve been socialised into ‘faulty’ ways of thinking. Again, if we’re coming from a person-centred perspective, and trusting in the client’s own wisdom, surely we should be valuing how they see things from the start.

Does this mean that clients don’t want empathy, or acceptance, or an intense relational encounter as well? Not at all. In fact, we didn’t even ask about those relational qualities because we figured that, for most clients, the choice between an ‘empathic’ or a ‘non-empathic’ relationship would just be a no brainer.

And does this research suggest we should all re-train as CBT therapists? No, of course not. For a start, there are clearly some clients who do want a less directive approach, or who have tried CBT and are now wanting something different.

More importantly, perhaps, I think that the kinds of qualities that clients are asking for are all things that can be incorporated into a person-centred, humanistic, or relational practice. What, I think, a lot of clients are saying is something like this, ‘I want a therapist who is going to be active, who is going to do things, who is going to “sit forward” rather than “sit back”’. It’s like what I’ve wanted when I’ve been for a massage. It may feel less painful if the masseur is soft and gentle, but what I really want is someone who is going to be digging their knuckles in, making things happen. Clients invest a lot in therapy—time, emotionally, and financially often—and I think what many of them are saying is, ‘I want you, as a therapist, to be really involved here. To do things. Not just to sit back and let me do all the work.’

So I do think these findings challenge some ways of being a person-centred, humanistic, or relational therapist (or psychoanalytic, for that matter). I think they challenge a fairly ‘passive’, non-involved, ‘neutral’ style—or one where the therapist sticks mainly just to reflecting the client, and doesn’t add too much beyond that. The limitations of such a style are also very evident from research we’ve done with young people, as well as findings from adult clients: that a passive, non-involved stance can really ‘freak’ some clients out. They want to feel that the therapist is a ‘real person’, with real thoughts and ideas. And if everything is just focused on them, it can feel very unnatural.

More than that, from a pluralistic person-centred stance, goals, structure, and skills training can all be part of our therapeutic work—if that’s what clients are wanting, we’re appropriately trained in it, and we’re happy to work in that way. So while we can’t ever be everything to every client, a pluralistic PCA always tries to put the needs and wants of the individual client before any rigidity or dogma of method. If a client wants it, and we can do it, and we can both see how it might be helpful, then why not!

One of the nice things about a pluralistic person-centred stance is also that we can be really open to whatever the research says, and not having to reinterpret it to fit our own needs and agendas. As Carl Rogers so beautifully puts it (and there’s a great book of this title :-) ):

…[T]he facts are always friendly. Every bit of evidence one can acquire, in any area, leads one that much closer to what is true. And being closer to the truth can never be a harmful or dangerous or unsatisfying thing. So while I still hate to readjust my thinking, still hate to give up old ways of perceiving and conceptualizing, yet at some deeper level I have, to a considerable degree, come to realize that these painful reorganizations are what is known as learning, and that though painful they always lead to a more satisfying because somewhat more accurate way of seeing life.

Finally, just to say, the whole point of this blog isn’t to argue that we should all, now, work in more active and directive ways with every client. From a pluralistic standpoint, different clients need different things at different points in time; so there’s undoubtedly some clients out there who really want—and need—us to be quieter and more sitting back. Rather, the point of this blog is to say that we should always try and stay open to each individual client, and not prefigure what they want or need. In fact, if I think about myself, I tend to prefer a therapeutic style that gives me lots and lots and lots of space. But then, I’m a therapist.

Person-centered therapy: A pluralistic perspective

Updated author final version of:

Cooper, M., & McLeod, J. (2011). Person-centered therapy: A pluralistic perspective. Person-Centered and Experiential Psychotherapies, 10(3), 210-223.

INTRODUCTION

Since the 1970s, the field of person-centered therapy has witnessed increasing differentiation (Lietaer, 1990), with the emergence of several distinctive “tribes” (Sanders, 2004; Warner, 2000). Some have questioned the legitimacy of certain members of this family (e.g., Brodley, 1990), but with an increasing emphasis on “inclusivity and the embracing of difference” within the PCE world (Sanders, 2007, p. 108), many now see this diversity as a positive quality to be prized (e.g., Cooper, O’Hara, Schmid, & Wyatt, 2007). From this standpoint, each of the members of the PCE family can be seen as drawing on, and developing, different elements of Rogers’ work. While those who identify with a “classical client-centered” standpoint, for instance, can be seen as orientating primarily around Rogers’ (1942) concept of nondirectivity (e.g., Bozarth, 1998; Brodley, 1990); emotion-focused/process-experiential therapists (e.g., Greenberg, Rice, & Elliott, 1993) can be understood as placing more stress on the affective experiences and processes that Rogers placed at the heart of the therapeutic enterprise (e.g., Rogers, 1959).

The aim of this paper is to introduce, and critically discuss, an alternative reading of what it means to be person-centered. This is one that is primarily rooted in the idiographic assumptions underlying the person-centered worldview: that each individual is distinct, and that the role of the therapist should be to facilitate the actualization of the client’s unique potential in the way that best suits the individual client.

PERSON-CENTERED VALUES: PRIZING THE UNIQUENESS OF HUMAN BEING AND BECOMING

Person-centered therapy, as with other humanistic and existential approaches, can be understood as a form of counseling and psychotherapy which puts particular emphasis on “conceptualizing, and engaging with people in a deeply valuing and respectful way” (Cooper, 2007, p. 11). As a consequence of this, a key element of person-centered thought is a rejection of psychological and psychotherapeutic systems which strive to reduce individual human experiences down to nomothetic, universal laws and mechanisms. Rather, there is an emphasis on viewing each human being “as a unique entity, unlike any other person who has existed or will exist” (Cain, 2002, p. 5). In other words, while person-centered theorists have argued that certain psychological features, such as the need for positive regard or conditions of worth (Rogers, 1959), are universal, there is a particular emphasis on the fact that each human being is distinctive, irreplaceable and inexchangeable. Levitt and Brodley (2005, p. 109), for instance, stated that client-centered therapy “is not centered on what a general client would or should be. It is not centered on a theory external to the client…. The focus of the therapist is entirely on understanding the client as an individual, in all his uniqueness, from moment to moment.”

In Rogers’s work, this idiographic emphasis is particularly evident in his assertion of the “fundamental predominance of the subjective” (Rogers, 1959, p. 191). Each individual, for Rogers (1951, p. 483), “exists in a continually changing world of experience of which he is the center”; and, given that this ever-changing phenomenological experiencing will be unique to the individual, the very essence of each human reality is distinct. Rogers’s (1942) idiographic emphasis is also evident in his critical stance toward diagnosis, preferring to view human beings as unique, individual organisms rather than as manifestations of trans-individual dysfunctional states.

This emphasis on the psychological irreducibility of each client, however, is not merely a theoretical assumption, but is rooted in a deep ethical commitment within the person-centered field to engaging with an Other in a profoundly honoring way. Here, the work of the French philosopher Emmanuel Levinas (1969, 2003) has been particularly influential (e.g., Cooper, 2009; Schmid, 2007; Worsley, 2006), with his emphasis on the “absolute difference” of the Other (Schmid, 2007, p. 39): that they are “infinitely transcendent,” “infinitely foreign,” “infinitely distant,” “irreducibly strange.” For Levinas, the Other always overflows and transcends a person’s idea of him or her, is impossible to reconcile to the Same, is always more than – and outstrips – the finite form that they may be afforded. From this standpoint, then, it is not just that each human being is unique, but that each human being is so unique that they can never be fully understood by an other: Their difference, at least to some extent, is transcendent. This is similar to Rogers’ (1951, p. 483) statement that the private world of the individual “can only be known, in any genuine or complete sense, to the individual himself.”

This idiographic emphasis within the person-centered approach is associated with a theory of psychotherapeutic change in which there is a particular emphasis on helping clients to actualize their distinctive potential and become their “own unique individual self” (Rogers, 1964, p. 130). Person-centered therapy (Rogers, 1957, 1959) aims to provide clients with a set of therapeutic conditions in which they can reconnect with their actual, individual experiences and valuing processes, moving away from a reliance on more external, “leveled down” (Heidegger, 1962) judgments and introjects.

An emphasis on the distinctiveness of each human being and their change processes also means that each individual’s needs and wants can be considered, at least to some extent, unique and unknowable. Bozarth (1998) wrote that the process of actualization – the motivational tendency underpinning all growth and development – “is always unique to the individual” (Bozarth, 1998, p. 29); and he described it as an “idiosyncratic” (Bozarth, 1998, p. 24) process that cannot be predicted (or determined) by another.

A commitment to supporting the actualization of the Other in their own, unique way also reflects a fundamental person-centered ethic of respect for the client’s autonomy (Keys & Proctor, 2007). Grant (2004) has argued that the basis for person-centered therapy lies in the ethic of “respecting the right of self determination of others” (Grant, 2004, pp. 158). Similarly, Cain (2002, p. 5) stated that “A fundamental value of humanistic therapists is their belief that people have the right, desire, and ability to determine what is best for them and how they will achieve it.” In Levinas’s (1969, p. 47) terms, this could be described as a fundamental ethical commitment to letting the Other be in all their Otherness: a “non-allergic reaction with alterity.”

TOWARD A PLURALISTIC PERSPECTIVE

At the heart of a person-centered approach, then, is an understanding that human beings may want and need different things, and that an individual’s distinctive wants and needs should be given precedence over any generalized theories that another holds about them. Extrapolated to the therapeutic process, this suggests that a basic person-centered assumption should be that clients are likely to want and need many different things from therapy – both things traditionally associated with PCE practice (such as empathic understanding responses) and things not (such as Socratic questioning) – and that any generic theories of change that we, as therapists, may hold, should be subordinate to the client’s specific needs and wants.

The hypothesis that different clients want different things from therapy is supported by empirical research (see Cooper & McLeod, 2011 for a review of the research). In a major trial (King, et al., 2000), for instance, primary care patients for whom a brief therapeutic intervention was indicated were given the option of choosing between nondirective counseling or cognitive-behavior therapy (CBT). Of those patients who specifically opted to choose one of these two therapies, around 40% chose the nondirective option, while 60% chose the CBT.

Of course, what clients believe they want is not, necessarily, what they need, nor what will necessarily be of greatest benefit to them. However, an emerging body of evidence indicates that different clients do, indeed, benefit from different types of therapeutic practices. While there is clear evidence, for instance, that most clients do best when levels of empathy are high (Bohart, Elliott, Greenberg, & Watson, 2002), there are some clients – individuals “who are highly sensitive, suspicious, poorly motivated” – who seem to do less well with highly empathic relationships (Bohart, et al., 2002, p. 100). There is also evidence that clients with high levels of resistance and with an internalizing coping style tend to do better in nondirective therapies, while those who are judged to be nondefensive and who have a predominantly externalizing coping style tend to benefit from more technique-orientated approaches (Beutler, Blatt, Alimohamed, Levy, & Angtuaco, 2006; Beutler, Engle, et al., 1991; Beutler, Machado, Engle, & Mohr, 1993; Beutler, Mohr, Grawe, Engle, & MacDonald, 1991).

Within the PCE field, this assumption – that different clients may benefit from different therapeutic practices (at different points in time) – has been articulated particularly well by Bohart and Tallman (1999). Process-experiential/emotion-focused therapists (e.g., Greenberg, et al., 1993) have also argued, and demonstrated, that particular therapeutic methods may be more or less helpful at particular moments in the therapy. In addition, from texts such as Keys’s (2003) Idiosyncratic Person-Centred Therapy and Worsley’s (2004) “Integrating with integrity,” it is evident that many person-centered therapists already incorporate a wide range of therapeutic methods into their work. Cain (2002, p. 44) wrote that one of the primary ways in which humanistic therapies have evolved is in their diversity and individualization in practice, and he went on to state that, ideally, humanistic therapists:

Constantly monitor whether what they are doing “fits,” especially whether their approach is compatible with their clients’ manner of framing their problems and their belief about how constructive change will occur. Although the focus of humanistic therapies is primarily on the relationship and processing of experience, they may use a variety of responses and methods to assist the client as long as they fit with the client’s needs and personal preferences.

In recent years, Cooper, McLeod, and colleagues have come to describe this standpoint, which prioritizes the therapist’s responsiveness to the client’s individual wants and needs, as a “pluralistic” one (Cooper & Dryden, 2016; Cooper & McLeod, 2007, 2011; McLeod, 2018). This is a stance which holds that “there is no, one best set of therapeutic methods,” and has been defined as the assumption that “different clients are likely to benefit from different therapeutic methods at different points in time, and that therapists should work collaboratively with clients to help them identify what they want from therapy and how they might achieve it” (2011, pp. 7–8). Cooper and McLeod’s pluralistic approach emerges from the person-centered values and practices discussed above, but it has been presented as a way of thinking about, and practicing, therapy which extends these values to the whole psychological therapies domain.

In terms of translating this general pluralistic stance into concrete therapeutic practice, Cooper and McLeod (2007, 2011) have emphasized two particular strategies. The first is to specifically orientate the therapeutic work around the client’s goals (or ‘directions’, Cooper, 2019), and the second is to develop the degree of negotiation, metacommunication, and collaboration in the therapeutic relationship.

CLIENTS’ GOALS AS AN ORIENTATING POINT FOR THERAPY

Cooper and McLeod (2007, 2011) have suggested that the goals that clients have for therapy can – and should – serve as an orientating point for thinking about, practicing, and evaluating therapeutic work. A client, for example, may want “to feel a sense of self-worth,” “to not experience anger and distrust toward my husband,” or “to be able to think about work without feeling stressed or panicky.” From a more classical person-centered standpoint, there is a risk that such a goal focus can lead to an overly mechanistic and ends-oriented approach to therapy, but there are several reasons why it is also highly consistent with a person-centered approach. First, it fits strongly with the concept of the client as active, meaning-orientated agent (Bohart & Tallman, 1999), who is engaged in constructing his or her life and relationships. Second, it privileges the client’s perspective – regarding what he or she want both in life and from therapy – over the therapist’s. Third, it moves away from a diagnostic, or even problem-centered, understanding of the client and the therapeutic process toward a potentiality-centered one – based around where the client wants to “go” in their lives. Finally, an orientation around the client’s goals may be the most explicit way of meeting, and responding to, the client as a self-determined, agentic subjectivity, who has the right to choose for him- or herself how he or she would like to pursue their own process of actualization. However, given that the term ‘goals’ can imply a more ends-oriented, cognitive emphasis, Cooper (2019) has suggested that the term ‘directions’ may be a more appropriate one: embracing embodied and unconscious, as well as cognitive and conscious, hopes, aspirations, and desires.

In order to help clients reach their goals, Cooper and McLeod (2007, 2011) have suggested that it may also be useful to think about the particular pathways by which these can be attained. Cooper and McLeod (2011, p. 12) refer to such possibilities as “tasks”: “The macro-level strategies by which clients can achieve their goals.” Examples of common tasks within therapy might include: “making sense of a specific problematic experience,” “changing behavior,” “negotiating a life transition or developmental crisis,” “dealing with difficult feelings and emotions,” and “undoing self-criticism and enhancing self-care.” Note, while process-experiential/emotion-focused therapists also refer to therapeutic “tasks” (e.g., Elliott, Watson, Goldman, & Greenberg, 2004), Cooper and McLeod use the term in a somewhat higher order sense: to refer to more general pathways or strategies. By contrast, the specific, micro-level concrete activities that clients and therapists undertake to complete these tasks are referred to as “methods,” such as “listening,” “participating in two-chair dialogue,” and “undertaking a guided visualization.” Cooper and McLeod also distinguish between the “therapist activities” that form one part of a therapeutic method and the “client activities.” Such a distinction may be useful when thinking about the kinds of therapeutic “methods” that clients may undertake outside of the immediate therapeutic relationship: for instance, reading self-help literature, exercising, or talking to friends and partners.

COLLABORATIVE ACTIVITY

This goal–task–method framework provides a means for therapists to think about what kind of therapeutic practices may be most helpful to a particular client. Of much more importance, however, is that it highlights three key domains in which collaborative activity can take place within the therapeutic relationship. For Cooper and McLeod (2007, 2011), such collaborative activity needs to be a key element of a pluralistically informed approach to therapy: maximizing the extent to which clients’ perspectives, wants and agencies can inform the therapeutic work. This activity has been described as metatherapeutic communication (Papayianni & Cooper, 2018), and it may be particularly appropriate in a first or early session of therapy: talking to clients about what they would like to get out of the therapeutic work, and how they feel that they might be able to get there. For example, a therapist might ask:

  • “Do you have a sense of what you want from our work together?”

  • “What do you hope to get out of therapy?”

  • “If you were to say just one word about what you wanted from this therapy, what would it be?”

  • “Do you have a sense of how I can help you get what you want?”

  • “What have you found helpful in previous episodes of therapy?”

  • “How would you like me to be in this therapeutic relationship: more challenging, more reflective?”

Although metatherapeutic communication is primarily orientated toward clarifying the client’s perspective, it by no means requires the therapist to ignore his or her own views and experience. Rather, the emphasis is on a dialogue between both members of the therapeutic dyad (Cooper & Spinelli, in press), in which therapist and client draw on their particular bodies of knowledge and expertise. Hence, the goals, tasks and methods of therapy emerge through a collaborative, negotiated dialogue; and may continue to be changed as the therapy unfolds.

An example of dialogue and metatherapeutic communication around a client’s goals for therapy comes from Mick’s work with a young man, Alex (details of clients have been changed to preserve anonymity). Alex was from a working class background, and had recently chosen to leave college feeling that he could no longer cope with his feelings of anxiety and depression. Alex began the session talking about his current difficulties, and the physical abuse he had experienced from his mother as a child.

Alex:    Obviously the fact that it was my mum that I got the abuse from makes it a lot harder. Because I kind of feel that people look at me a little bit – There’s always this sense of attack.

Mick:   There’s an underlying sense of attack from people.

Alex:    It’s kind of paranoid in a way. It kind of annoys me that I’m still doing it, but it doesn’t make any difference. It doesn’t stop. It’s not even getting gradually better now that I’ve realized – everything’s just exactly the same, but … more frustrating because I know that it’s going to take time, but I feel that I’m kind of at a standstill, and don’t know really where to go ….

At this point, Mick invited Alex to try and specify more clearly where he would like therapy to take him to with this difficulty.  

Mick:   So, if we were to, kind of, think about specific things that you’d want from the counseling, it sounds like one of the things would be around – what would it be? Would it be about not wanting to experience people as so critical or … How would you phrase some of the things that you’d want? So – where – like in 15 or 20 sessions, where would you like to be at the end of it, in contrast to now?

Alex:    I suppose I’d like to improve my personal relationships, in the sense that I have more self-worth. Because … mm … in arguments and upsets … I value myself a lot less than I should. I just let people get their own way, just because it makes things easier …. I take a lot of hits from other people.

Mick:   So there is something about wanting to feel more of a sense of self-worth?

Alex:    Yeah, in that I can make these objections and that my feelings are equal to the other persons.

Mick:   So something about being able to feel that my opinions and what I want is valid, and not put other people’s first.

Alex:    Yeah.

These goals, as identified by Alex, then served as an orientating point to the ongoing therapeutic work.

A second example of this dialogical process, with respect to collaboration around therapeutic methods, comes from McLeod’s work with a young male client, Haruki.

During one of the early sessions that focused on the task of dealing with his panic feelings, John and Haruki talked together about the various ways that Haruki thought that it might be possible for them to address this issue. John wrote down the ideas that emerged, on a flipchart. Haruki began by saying that the only thing that came to mind for him was that he believed that he needed to learn to relax. John then asked him if there were any other situations that were similar to performing in seminars, but which he was able to handle more easily. He could not immediately identify any scenario of this type, but later in the session he returned to this question, and told John that he remembered that he always took the penalties for his school soccer team, and dealt with his anxieties by running through in his mind some advice that he had received from his grandfather, about following a fixed routine. John then asked him if he would like to hear some of John’s suggestions about dealing with panic. John emphasized that these were only suggestions, and that it was fine for him to reject them if they did not seem useful. John mentioned three possibilities. One was to look at a model of panic, as a way of understanding the process of losing emotional control. The second was to use a two-chair method to explore what was going on in his mind, in terms of what he was internally saying to himself at panic moments. The third was to read a self-help booklet on overcoming panic. (Cooper & McLeod, 2011, p. 93)

From a person-centered standpoint, one counterargument to this call for greater metahtherapeutic communication (as mentioned above) might be that what clients want in therapy – or what they believe themselves to want – is not necessarily what they need. Clients may have introjected, for instance, certain beliefs about what will be most helpful to them (such as external advice or suppression of emotions), and this may run counter to their actual organismic valuing (Rogers, 1959). As indicated above, however, metatherapeutic communication does not simply involve doing whatever the client wants; if the therapist has a different view of what might be helpful, this is something that can be brought into the dialogue. Having said that, any therapeutic approach which claims to be client-centered needs to be very careful not to dismiss, minimize, or override a client’s own views of what it is they want. Moreover, research suggests that clients who get the therapeutic interventions that they want do tend to experience more benefit, and are much less likely to drop out, than those who do not (Swift, Callahan, Cooper, & Parkin, 2018).

A second counterargument to this call for greater metacommunication may be that it overemphasizes verbal and conscious communication processes in the therapeutic relationship, and overlooks the value of more subtle, nonconscious, and intuitive understandings: such as the therapist’s felt-sense of what the client needs, or their embodied empathic understanding (Cooper, 2001). However, research tends to suggest that therapists, in fact, are generally not that good at accurately intuiting what their clients really want or are experiencing (see Cooper, 2008, p. 2). Moreover, a substantial body of research on “client deference” indicates that clients are often very wary of communicating to their therapists what it is that they really want or need (Rennie, 1994) – including to person-centered therapists – and will often hide things from their counselors or psychotherapists (Hill, Thompson, Cogar, & Denman, 1993). Hence, although overt, explicit communication may not be the only channel through which therapists can develop a greater understanding of their clients’ actual wants and needs, empirical research suggests that this is one mode of communication that many therapists could utilize more fully.

Indeed, given the difficulties that clients may have directly expressing their goals, wants, and preferences to their therapists, pluralistic therapists have suggested a range of tools and measures that therapists may want to incorporate into the therapeutic process. For instance, the Cooper-Norcross Inventory of Preferences (Cooper & Norcross, 2016) invites clients to indicate on a range of dimension how they might like their therapist to be: such as, “Be more challenging – Be more gentle,” and “Focus more on my feelings – Focus more on my thoughts and cognitions,” (download from here). Another tool that has been developed is the Goals Form (download from here) where clients’ goals for therapy can be jotted down in an early session (and revised if necessary), and then rated every week on a 1 (Not at all achieved) to 7 (Completely achieved) scale. For Alex (discussed above), for instance, three of his identified goals were to “Feel a sense of self-worth,” “Feel that my opinions and wants are valid in relationships,” and “Not interpreting what others say and do in critical way.” At assessment, the average rating across these three items was 1.33 (i.e., very close to “Not at all achieved”) and, by session five, had increased to 3.

IMPLICATIONS FOR ESTABLISHED PERSON-CENTERED AND EXPERIENTIAL THERAPIES

A pluralistic reading of person-centered therapy does not, in any way, challenge the value or legitimacy of other perspectives and practices within the PCE field. Nor does it call on all PCE therapists to be more integrative in their work. Cooper and McLeod (2011) make a clear distinction between pluralism as a perspective on psychotherapy and counseling, and pluralism as a particular form of therapeutic practice. Hence, a therapist who offers classically orientated client-centered therapy could still subscribe to a pluralistic viewpoint: believing that there are many different ways of helping clients, even though they choose to specialize in just one. More specifically, it may be useful to think about a pluralistic approach as residing on a spectrum: from a simple acknowledgment of the value of different therapeutic methods; to an enhanced use of goal orientation, metacommunication and negotiation in the therapeutic work; to a therapeutic practice that draws on methods from a wide range of orientations.

Even at a most minimal level, however, what a pluralistic perspective does offer is a challenge to the assumption that any one person-centered perspective, method or set of hypotheses holds some kind of “metanarrative” status (Lyotard, 1984): that it is true, or superior, for all people at all times. More than that, it challenges “dogmatic person-centeredness” (Worsley, 2001, p. 25): the belief that person-centered and experiential theories or methods are in some, generic way superior to other therapeutic practices and understandings. Rather, it invites members of the person-centered community to hold our person-centered theories and practices “lightly,” and to be open to challenges and different viewpoints from both within, and outside of, the person-centered field. At this level, it invites us to be “person-centered” about person-centered therapy: nondefensive, open to a range of experiences, and willing to be “in process” rather than holding a fixed and rigid concept of self (Rogers, 1961).

A pluralistic perspective also invites PCE therapists to be more explicit about the particular ways in which our therapies may be able to help people; and the kinds of clients and contexts for which they may be most likely to be helpful. Person-centered and experiential therapists, for instance, might find it useful to undertake a “personal audit,” looking at the kinds of goals they feel most able to help clients to achieve, and the particular methods they would have for getting them there. This is something that might then be made clearer to clients prior to starting therapy, such that clients are more enabled to decide whether or not a PCE therapy is right for them. Further empirical research would be particularly helpful in this regard. For instance, we already know that clients with high levels of reactivity tend to be more likely to benefit from nondirective methods than clients with low levels of reactivity, but are there other groups of clients, or problems, or goals for which PCE methods or a PCE attitudinal stance may often be of greatest help?

Finally, for those interested in moving toward a more pluralistic practice, the pluralistic strategies outlined by Cooper and McLeod (2011) may help PCE practitioners to enhance their work through greater dialogue around the goals, tasks, and methods of therapy. And for PCE practitioners who are interested in incorporating other methods into their work, it provides a framework in which this can be achieved in a coherent and client-centered way.

DISCUSSION

Our hope is that the articulation of a pluralistic understanding of what it means to be person-centered will bring something fresh and vibrant to the person-centered field, even if it primarily involves the explication of something that has always been implicit. First, a pluralistic perspective offers PCE therapists a means of resolving the tension between commitment and antidogmatism (Hutterer, 1993). It provides a conceptual framework in which PCE therapists can feel proud of the work that they do and can develop and deepen this specialism, while at the same time avoiding a judgmental attitude toward other therapeutic orientations. More than this, it has the opportunity to give PCE therapists a unique identity in the therapeutic field: as champions of inclusivity and mutual respect across therapies. Second, closely related to this, it facilitates the building of bridges with other progressive, client-orientated approaches, such as the “client-directed” practices of Duncan, Hubble, Sparks and colleagues (2004) and the work of many postmodern-informed family therapists (see Sundet, 2011). Third, a pluralistic perspective on therapy provides a means of conceptualizing, not just processes within the counseling and psychotherapeutic domain, but the whole range of personal development activities. In this way, a pluralistic perspective can help the person-centered and humanistic field move away from an exclusive focus on how professional therapists “bring about” change in clients, and toward a more client-orientated and client-agentic stance (Bohart & Tallman, 1999). Fourth, a pluralistic viewpoint provides a means by which person-centered practices can be more fully opened up to new and emerging research – as well as new theories and ideas – such that it can remain a growing and actualizing field. Closely linked to that, it provides a framework for researching and thinking about the complex question of how therapists can most constructively engage with our clients’ individual wants and needs. Finally, for some person-centered practitioners, the development of a pluralistic practice may allow them to grown more fully as therapists. It provides a highly flexible model of practice in which therapists can incorporate, and advance, whatever potentialities, strengths and resources they have. If, as Rogers’ (1961, p. 158) suggested, the fully functioning person is not rigid in their constructs, but an “integrated process of changingness,” then a pluralistic form of practice may offer some PCE practitioners a means of moving to a more fluid and creative actualization of their full potentialities.

In summary, from a pluralistic perspective, to be person-centered means to be someone who acknowledges the vast diversity and unknowability of human being, and who prizes the unique needs and wants of each individual client. It means to be someone who puts their clients wants for therapy before their own assumptions about what those wants might be, and who strives to be responsive within the limits of their own training, expertise and interest. For some person-centered therapists, it may also mean drawing on a variety of therapeutic methods from both PCE and non-PCE sources. Whether or not a therapist practices pluralistically, however, a pluralistic person-centered standpoint means an acknowledgment and prizing of the many different ways in which non-PCE therapies can be of value to clients; while also a recognition of the power and depth of the established PCE approaches.

FAQs (2019)

Isn’t pluralism just what a lot of people do anyway? Yes, absolutely, and so we’re not suggesting a new model of practice. But putting words and terms to what we do may help us develop, research, and more deeply understand that way of working.

What’s the difference between ‘pluralism’ and ‘integration’? Two main things. First, from a pluralistic standpoint we put a particularly strong emphasis on the collaborative relationship between therapist and client—metatherapeutic communication—which is there in many integrative forms of therapy but is not implicit to integration per se. For instance, you could have an integrative approach that is very strongly therapist-led. Second, pluralism is proposed as a framework and set of values, as well as a particular form of practice, whereas integration does refer to a particular practice. So you could say, for instance, ‘I practice person-centred therapy from within a pluralistic standpoint,’ but it wouldn’t make sense to say ‘I practice person-centred therapy from within an integrative standpoint.’

But Rogers talks about being flexible with, and responsive to, clients. So how is pluralistic therapy any different? If person-centred therapy is practiced in a genuinely flexible way, where we’re responding to what clients want and need with all of our skills and expertise, then the differences may well be very limited. But pluralism means respecting the wide diversity of methods that may be very helpful to clients—above and beyond empathy, acceptance, and congruence—such as psychoeducation, skills training, and interpretations. Some person-centred therapists, no doubt, do incorporate such methods into their work (with appropriate training and experience) and if that’s in response to client need, then that’s absolutely pluralistic.

Surely a therapist can’t know every different method going. Absolutely, and pluralism is not about being able to give everything to everyone. It’s about recognising what we can and cannot do and being flexible within that.

Isn’t there a danger that the pluralistic therapist ends up just being a chameleon and inauthentic: a different person to each client? That’s certainly a risk, and one of the challenges of pluralism is to try and meet, as well as possible, the client’s wants and needs, while staying true to one’s own self, knowledge, and expertise. So the first step in pluralism is for the therapist to be really aware of what they can, and cannot, offer to a client—where their boundaries are—so they know what they’re able, and willing, to offer. Remember that shared decision-making is not simply a ‘patient choice’ model, whereby the therapist hands over all responsibility to the client. Rather, it’s a dialogical approach that sits midway between paternalistic and ‘patient choice’ approaches to healthcare.

How can you just combine therapies with fundamentally different theoretical assumptions about the person: like person-centred therapy and CBT? Research shows that the differences here are often much more ‘real’ to therapists than clients. If you look at the research on what clients find unhelpful, they rarely say things like, ‘The therapist combined too many approaches,’ or, ‘Their epistemological assumptions just didn’t match their ontologies.’ Clients, in general, are much more interested in real, practical solutions to their problems, and often appreciate a therapist who is willing to draw on whatever skills and knowledge they have to help that as much as possible.

So does pluralism actually have any consistent, underlying philosophy? Yes. Pluralism, itself, is an underlying philosophical framework, see for instance the work of Isaiah Berlin or Nicholas Rescher. Importantly, we can distinguish between a ‘foundational pluralism’, which is akin to relativism, and a more moderate ‘normative pluralism’, which is underpinned by a unified set of values. What are those? More than anything else, pluralism means an ethics of ‘welcoming otherness’: a commitment to being open, appreciative, and respectful of difference. In that sense, as with Levinas, it puts ethics as ‘first philosophy’: that how we treat others is the most fundamental issue, and a starting point for philosophical questioning that precedes ontology, epistemology, or other philosophical concerns.

What about clients who don’t know what they want from therapy, or what they’d prefer? Something that’s increasingly clear from our research is that clients do, indeed, differ very much in how much they know about therapy, and how clear they are about their own goals or preferences. So a pluralistic approach to therapy doesn’t just mean ‘handing the ball’ to the client and expecting them to do all the work. It’s a dialogical approach, where both therapist and client bring together their understanding and respective expertises to work out what is best for the client.

From a person-centred perspective, the person has the answers within them—their inner growth tendency—so why should they need more from the therapist than contact, empathy, UPR, and congruence? Theoretically, that’s where a pluralistic approach would differ from a purely person-centred approach. Pluralistically, the sources of potential healing are plural. So they definitely might come from ‘within’ the person, but also from ‘without’: books, learning, other people, pets… Rogers developed his ideas as a much needed counterbalance to the behaviourism of his time, which focused solely on external learning. But, taken in isolation, person-centred theory may veer too far the other way, and forget that external learning can be a crucial source of growth too.

Can’t pluralistic therapy end up being a ‘school’ of therapy in itself, with its own dogma, certainty, and closed-mindedness? Yes, that’s absolutely a risk, and one that we’ve tried to be mindful of from the start. So we’ve always advocated holding pluralism lightly, and in a self-critical and reflexive way. And if you look at our literature and research, you can, hopefully, see how the approach has grown and evolved as we’ve seen that some things work better than others. For instance, my latest work on directionality emerged in response to criticisms about ‘goals’ and the somewhat mechanistic, ends-oriented nature of that concept.

Where can I find out more information about pluralism in therapy? A good starting point is the Pluralistic Practice Network website. You can also find some resources and papers on the pluralistic therapy training page on this site.

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What is Pluralism?

Pluralism is a spirit of welcoming, warmth, and care to the other. It is a willingness to engage in dialogue. It is an openness to being wrong and to learning. Pluralism says, ‘How I see things is one way of seeing the world and I want to value—and learn from—others.’

Pluralism isn’t easy. It’s a constant willingness to self-challenge and to look at where we might be wrong, or limited; even with regard to pluralism itself. It requires a capacity to detach ourselves from our agendas, our beliefs, our commitments, and to recognise that there may be other ways. And it also requires us to recognise that we can never wholly achieve that: that we will always have things that we want and that there’s always the possibility of taking a step further back.

Pluralism isn’t just a stance of ‘anything goes’. Of course, there’s a plurality of pluralistic perspectives, but the kind of pluralism that appeals to me most is a ‘foundational pluralism’, in which pluralistic ideas and practices are embedded in a more singular set of values. What are those values? Most fundamentally, for me, it’s an ethic of ‘holding open a space for otherness’: supporting difference and diversity to thrive.

So pluralism is not just a passive, wishy-washy, relativistic acceptance of everything. At times it needs to be militant. A willingness to really fight to hold that space open if others are threatening to close it down. Pluralism challenges, vigorously, ideologies that claim to be single and superior truths—and even more so those that impose their ‘truths’ on others. It doesn’t challenge the possibility of their ideas; but, like postmodernism, it challenges any single claim to metanarrative status. In foundational pluralism, care for the other is not a relative value but a fundamental ethic: the grounds from which a pluralistic prizing of difference and diversity grows.

Pluralism is there in a wide diversity of domains. In therapy, in religion, in politics. It’s there in the writings of Isaiah Berlin, William James, Carl Rogers, and many others. And, most of the time, a pluralistic standpoint is implicit rather than explicit: in appeals for tolerance, or social justice, or dialogue. And it’s hallmark is that critical, non-dogmatic self-reflexivity which strives to hold open spaces for us all, while also recognising our tendencies to try and shut them down. It is characterised by humility, by a quest for a learning, and by a deep love for others and a prizing of the unique contribution that each of us can make.

(Image By ESA/Hubble, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=8788068)

Carl Rogers's 'core conditions': Are they necessary and sufficient?

It’s the essay title just about every person-centred student has to address at some point in their training: Was Rogers right to claim, as he does in his classic 1957 paper, that the therapist’s (a) congruence, (b) unconditional positive regard, and (c) empathic understanding are necessary and sufficient conditions for therapeutic personality change to occur (along with (d) therapist—client contact, (e) client vulnerability, and (f) the therapist’s communication of these conditions)? Rogers’s hypotheses were based on the available research of his time, and were an amazingly insightful and succinct reading of it. But over 60 years have elapsed since Rogers put forward his position: Does it still stand up to the evidence?

Let’s start with 'necessary’. That means that those first three ‘therapist-provided’ conditions (along with the three ‘relationship’ and ‘client’ conditions) needs to be there for therapeutic personality change to occur. Here, the research suggests a resounding ‘no’. The problem is, it’s evident that therapeutic personality change can happen through a variety of mechanisms where there really isn’t much of a relationship at all. For instance, James Pennebaker has shown that writing about emotional experiences (as with keeping a diary) can be a profoundly therapeutic experience; and there is good evidence that online therapies can be as helpful as face-to-face therapies, often with minimal interpersonal contact. Have you ever watched a film that has had a profound effect on you, or read a book that has moved you to see life in a really different way? If so, it’s really not possible to claim that any kind of relationship factors are necessary conditions for therapeutic personality change.

What about ‘sufficient’? Well, yes, the very latest research does show that each of Rogers’s core conditions are associated with positive therapeutic change. But it’s not necessarily the case from that that they are causing the change. It may be, for instance, that clients who improve then start to feel that their therapists are more accepting and empathic. I know, for instance, that if my doctor gives me some good news, I tend to like them more. And what the evidence also shows is that Rogers’s core conditions are just three of many different relationship factors that are associated with positive outcomes. For instance, alignment on the goals of therapy also seems to be important, and then there’s the therapist’s capacity to deal with ruptures in the alliance, and the use of systematic client feedback. All of these factors are closely related to Rogers’s conditions, but it suggests that the ones Rogers identified don’t have some kind of ‘magical significance’: they’re three factors amongst a sea of inter-related relational variables that all, together, are associated with positive outcomes. Add to that is the problem that, for different clients, Rogers’s therapist-provided conditions may be more or less helpful. For instance, research into empathy shows that, for some clients—highly sensitive, suspicious, and poorly motivated—very high levels of empathy may be counter-productive. Certainly, some clients can feel that a therapist is just too positive, or too in their shoes, or too present and full on. And, finally, there’s some very good evidence, both quantitative and qualitative, that clients can really value, and benefit from, ‘non-relational’ interventions, like normalisation through therapist’s expert knowledge, or ‘behavioural activation’. Maybe the relational elements of these therapeutic encounters are sufficient to bring about some degree of change, but to just focus on that would be to ignore what some clients, themselves, are saying matters most.

The problem with Rogers’s hypothesis is that, in many ways, they’re not very ‘Rogerian’: in the sense that they assume everyone responds in the same way, without taking into account individual differences. When you say things are ‘necessary and sufficient’, the inference is that this is going to be true for us all, and that doesn’t allow for people to respond to therapies in different ways. That’s why John McLeod and I have been arguing that one way of really embodying person-centred principles is through a pluralistic approach to therapy: acknowledging the many different ways in which clients can be helped and the individual differences in what works for each of us (see blog on Person-centred therapy: A pluralistic perspective). I’m sure that Rogers, like most of us in the person-centred field, would have wanted to respect those differences; and no doubt his ‘conditions’ were an attempt to speak the language of his times: scientistic, nomothetic (i.e., universal), and absolute. In fact, I remember reading somewhere that he does acknowledge that it probably wasn’t the best way of phrasing things. If he’d said something like ‘congruence, empathy, and unconditional positive regard are incredibly important elements of therapy for many people, much of the time’, he’d have been absolutely spot on. It’s a bit less snappy, but 60 years later he would have still been absolutely spot on with what the evidence is telling us, and that’s an amazing thing.

So what would Rogers say now. Reading the evidence, very closely as he did, I’d like to think he’d say something like the following. What we know is that the quality of the therapeutic relationship is one of the best predictors of outcomes; and a growing body of research is beginning to show that it does, indeed, have the capacity to catalyse positive change. For lots of clients, having a good quality therapeutic relationship—empathic, trustworthy, and caring, for instance—can have an enormous impact, just in itself; and for others, it can be an essential vehicle through which other change processes can happen. However, different clients need different things: and it may be that some clients need more: more psychoeducation, or more challenge, or more interpretation. Different people are different. So nothing is necessary and sufficient for everyone. But if you want to practice therapy in a safe and effective way, then establishing an empathic, honest, and unconditionally accepting relationship is, for most clients, one of the best things that you can do.

Synergies are Good: Why ‘Win-Win’ Configurations Matter More than you Might Think

How can you help people make positive changes in their lives?  

If you’re starting from the position that people are getting things wrong—maladjusted, dysfunctional, misinformed, etc.—then it’s pretty straightforward: teach them the ‘right’ way to do things.  But if your starting point is that people are already doing their best—for instance, that they have an ‘actualising’ tendency, as the humanistic and person-centred therapies hold—then it gets more complicated.  Because how do you help someone who is already actualising to actualise more?

One way of tackling this might be to say that, ‘Ok, the person does have a potential to actualise, but the problem is that the environment they’re in gets in their way.’  So it’s not that the person isn’t capable of actualising, it’s that their world isn’t letting them.  Problem is, that then makes the person little more than a pawn to their world.  Are we really so powerless?  And, if so, what does that say about the human being’s natural capacity to actualise?

For people who believe in an innate human ability to ‘grow’ and act in prosocial ways, there’s a similar paradox at the socio-political level.  It’s easy enough to explain social ills if we start from the premise that people can be intrinsically selfish and competitive; but if people are inherently prosocial, how do you explain gun crime, or homophobia, or Nazism?  How can something so bad come out of something so potentially good?

This is where the concept of ‘synergies’—and its opposite, dysergies—comes in.  Synergies are win–win relationships: where two things go together to make something more than either alone.  Let’s take a really simple example.  Narek wants to be in a relationship and so does Paul.  Narek and Paul get into a relationship together.  Now they’ve both got more together than either had alone.  So we can say here that there’s a synergetic relationship between Narek’s desire for a partner and Paul’s desire for a partner: because the more that one of these things happens the more the other thing does too.

Synergies have been described by Peter Corning as ‘nature’s magic’ and, in a way, they are magical, because they make something out of nothing.  They’re where 1 + 1 = 3.  Here’s Narek, and here’s Paul, and without either bringing in more than what they’ve had, they’ve managed to create something more than what they were.  That’s amazing, isn’t it—something out of nothing?

Synergies don’t just operate between people, they operate within people as well.  Say Narek, like most of us, wants to feel good about himself, and he also wants to have a relationship with another man.  So if he can feel good about himself as a gay man, he’s got a win–win relationship on the inside too. 

Contrast that with a dysergetic internal relationship, where Narek doesn’t feel good about being gay.  Now his choice is to either (a) express his gay side and feel bad about himself, or (b) try and feel good about himself by suppressing his gay side. But either way he loses out: 1 + 1 = 1.

What this example should also begin to show is how the concept of synergies and dysergies can answer the opening question in our blog. Because it’s totally fair enough that Narek wants to feel good about himself, and it’s totally fair enough that he wants to express his gay side.  Both of those are parts of his actualising being.  But because they are pulling against each other, he ends up getting less out of life than he could otherwise.  He’s an actualising being that’s not actualising to his full potential.  And it’s not because he’s maladjusted, dysfunctional, or misinformed; it’s because the things he’s trying to do, with the best will in the world, are dysergetically-related rather than synergetically-related.

Ok, so here’s where I want to make a really bold claim.  I think that nearly everything we do in therapy, whatever orientation, and whether we consciously call it as such or not, is about helping clients reconfigure their ways of doing things so that they are more synergetic.  What we do is we help them think about their lives and how they’re acting, reflect on what’s working and what isn’t, and then think about ‘better’ ways of moving forward (better, of course, for the client, not for us).  So that might mean, for instance, reflecting on ‘defensive’ strategies that have emerged in their childhood, and thinking about whether they want to continue with that; or looking at black-and-white patterns of thinking and seeing if it’s better to see shades of grey.  And it may also be about helping clients to process things at more embodied levels: for instance, to really feel their anger and hurt towards their parents, and to recognise that those feelings are really legitimate.  But, in all of this work, what we don’t do is to pathologise their ‘unhelpful’ ways of doing things.  We don’t intimate to clients, for instance, that their defense mechanisms are really dumb, or that black-and-white ways of thinking are just pointless.  And the reason we don’t is because we can see the intelligibility of these ways of doing things: of course, it makes absolute sense that we want to protect ourselves, or that we want to see the world in more simple ways.  It’s just that those ways of doing things act against us in other ways and are ultimately unproductive. So the question is not about right or wrong, but about how we can get all our needs met in ways that support each other: i.e., how we can be more synergetic.

So I’m suggesting that positive change at the individual level works through the development of synergies; and I think positive change at the social and political level can be conceptualised in a similar way too.  Two communities talk across their differences and start to value each other, nations move from the ultimate dysergetic state—war—to peaceful co-existence, people learn to live in synergetic harmony with their environment.  Groups, striving to do their best, strive to do their best in ways that other groups can also do their best. 

This is a humanistic perspective: not a radically socialist or a radically libertarian one. It’s a politics of understanding rather than a politics of blame. It’s saying that people, even when they act in oppressive or highly damaging ways, aren’t generally setting out to do so. Rather, even the most oppressive people are essentially like us: trying to get their needs met. Only they’re doing it in ways that are incredibly dysergetic to the rest of us, and not always willing to recognise that they’re doing so.

What does any of this mean in terms of what we can do—at the personal or socio-political level—if we want to try and make things better?  In my just published book, Integrating counselling and psychotherapy: Directionality, synergy, and social change (Sage, 2019), I try and outline some of the principles by which synergies can be developed, whatever the level.  There’s establishing trust, and communicating more clearly, being assertive, and embracing creativity and difference and diversity. 

I guess my hope is that, by seeing positive change in this light, we can begin to try and understand the common principles that make things synergetic or not.  As things stand, the development of synergies is always implicit: an underlying process that we try and make happen, without much conscious thought.  Perhaps we can move to a place where we more consciously think, ‘How can we create synergies here?’  And we can also look at the limits and challenges of synergetic processes (for instance, over-compromise), and perhaps develop even deeper and more integrative principles of positive change.

Perhaps, most importantly, what the concept of synergies does is allow us to understand people, and societies, as doing best but could also do better. It means that we can engage with people in deeply respectful ways, while also holding on to the potential for improvement and change. That’s something that, albeit implicitly, is right at the heart of our therapeutic work. And if we can also put that ethos at the heart of social and political change activities, I really believe it maximises our abilities to bring good things about.

Publishing your research: Some pointers

The following pointers are for trainees, professionals, and academics in the counselling and psychotherapy field who have completed a research project—or are working towards its completion—and would like to get it published  They are particularly oriented towards doctoral (or master’s) level trainees who would like to ‘convert’ their research into journal publications.

 Many thanks to Jasmine Childs-Fegredo, Mark Donati, Edith Steffen, and trainees on the University of Roehampton Practitioner Doctorate in Counselling Psychology for comments and suggestions. 

Why bother?

Let’s say this, up front: it’s hard work getting your research published.  It’s not just a case of cutting and pasting a few bits of your thesis, or reformatting an SPSS table or two, and then sending it off to the BMJ for their feature article.  So before you do anything, you really need to think, ‘Have I got the energy to do it?’ ‘Do I really want to see this in print?’ And being clear about your reasons may give you the motivation to keep going when every part of you would rather give up.  So here’s five reasons why you might want to publish your research.

  1.  If you want to get into academia, it’s pretty much essential.  It’s often, now, the first thing that an appointment panel will look at: how many publications you have, and in what journals. 

  2. Even if your focus is primarily on practice, a publication can be great in terms of supporting your career development.  It can look very impressive on your CV—particularly if it’s in an area you’re wanting to develop specialist expertise in.  Indeed, having that publication out there establishes you as a specialist in that field, and that can be great in terms of being invited to do trainings, or teaching on courses, or consultancy.

  3. It’s a way of making a contribution to your field—and that’s the very definition of doctoral level work.  You’ve done your research, you’ve found out something important, so let people know about it.  If you’ve written a thesis, it may just about be accessible to people somewhere in your university library, but they’re going to have to look pretty hard.  If it’s in a journal, online, you’re speaking to the world.

  4. …And that means you’re part of the professional dialogue.  It’s not just you, sitting in your room, talking to your cat: you’re exchanging ideas and evidence with the best in the field—learning, as well as being learnt from.

  5. You owe it to your participants.  For me, that’s the most important reason of all.  Your participants gave you their time, they shared with you their experiences—sometimes very deeply.  So what are you going to do with that?  Are you just going to use it to get your award—for your own private knowledge and development; or are you going to use it to help improve the lives of the people that your participants represent?  In this sense, publishing your work can be seen as an ethical responsibility.  

Focus

If you’ve written a thesis—and particularly a doctoral one—you may have been covering several different research questions.  So being clear about what you want to focus on in your publication, or publications, may be an important next step.  Get clear question(s), and be clear about the particular methods and parts of your thesis that answer them.  That means that some of your thesis has to go.  Yup, that’s right: some of that hard fought, painful, agonised-over-every-word-at-four-in-the-morning will have to be the mercy of your Delete key.  That can be one of the hardest parts of converting your thesis to a publication—it’s a grieving process—but it’s essential to having something in digestible form for the outside world.

And, of course, you may want to try and do more than one publication.  For instance, you might report half of your themes in one paper, and then the other half in another paper; or, if you did a mixed methods study, you could split it into quant. and qual.  Or you might divide your literature review off into a separate paper, or do a focused paper on your methodology.  ‘Salami slicing’ your thesis too much can end up leaving each bit just too thin, but if there’s two or more meaningful chunks that can come of your work, why not? 

Finding the right journal

This is one of the most important parts of writing up for publication, and easily overlooked.  Novice researchers tend to think that, first, you do all your research, write it up for publication, and then only at the end do you think about who’s going to publish it.  But different journals have different requirements, different audiences, and publish different kinds of research; so it’s really important to have some sense of where you might submit it to long before you get to finishing off your paper.  That means you should have a look at different journal website, and see what kinds of papers they publish and who they’re targeted towards—and take that into account when you draft your article. 

Importantly, each journal site will have ‘Author Guidelines’ (see, for instance, here) and these are essential to consult before you submit to that journal.  To be clear, these aren’t a loose set of recommendations for how they’d like you to prepare your manuscript.  They’re generally a very strict and precise set of instructions for the ways that they want you to set it out (for instance, line spacing, length of abstract), and if you don’t follow them, you’re likely to just get your manuscript returned with an irritated note from the publishing team.  Particularly important here is the length of article they’ll accept.  This really varies across journals, and is sometimes by number of pages (typically 35 pages in the US journals), sometimes by number of words (generally around 5-6,000 words)—and may be inclusive of references and tables, etc., or not.  So that’s really important to find out before you submit anywhere, as you may find out that you’re thousands of words over the journal’s particularly limit.  Bear in mind that, particularly with the higher impact journals (see below), they’re often looking for reasons to reject papers.  They’re inundated: rejecting, maybe, 80% of the papers submitted to them.  So if they don’t think you’ve bothered to even look at their author guidelines, they may be pretty swift in rejecting your work.  

So which journals should you consider?  There’s hundreds out there and it can feel pretty overwhelming knowing where to start.  One of the first choices is whether to go with a general psychotherapy and counselling research journal, or whether something more specific to the field you’re looking at.  For instance, if your research was on the experiences of clients with eating disorders in CBT, you could go for a specialised eating disorders journal, or a specialised CBT journal, or a more general counselling/psychotherapy publication.  This can be a hard call, and generally you’re best off looking at the journal sites, as above, to see what kind of articles they carry and whether your research would fit in. 

 Note, a lot of psychotherapy and mental health journals don’t publish qualitative research, or only the most positivist manifestations of it (i.e., large Ns, rigorous auditing procedures, etc.).  It’s unfortunate, but if you look at a journal’s past issues (on their site) and don’t see a single qualitative paper there, you may be wasting your time with a qualitative submission: particularly if it’s underlying epistemology is right at the constructionist end of the spectrum.  And, if you’re aiming to get your qualitative research published in one of the bigger journals, it’s something you may want to factor in right at the start of your project, with a larger number of participants and more rigorous procedures for auditing your analysis.

You can also ask your supervisor, if you have one, or other experienced people in the field, where they think you should consider submitting to.  If they’ve worked in that area for some time, they should have some good ideas.  

Impact factor

Another important consideration is the journal’s impact factor.  This is a number from zero upwards indicating, essentially, how prestigious and reputable the journal is.  You can normally find the impact factor displayed on the journal’s website (the ‘2 year’ impact factor is the one you want).  To be technical, the impact factor is the amount of times that the average article in that journal is cited by other articles over a particular period: normally two years.  So the bigger the journal’s impact factor, the more that articles in that journal are getting referenced in the wider academic field—i.e., impact.  The biggest international journals in the psychotherapy and counselling field will have an impact factor of 4 or 5, and ones of 2 or 3 are still very strong international publications.  Journals with an impact factor around 1 may tend towards a national rather than international reach, and/or be at lower levels of prestige, but still carrying many valuable articles.  And some good journals may not have impact factors at all: journals have to apply for one and in some cases the allocation process can be somewhat arbitrary.

 Of course, the higher the journal’s impact factor, the harder it is to get published there, because there’s more people wanting to get in.  So if you’re new to the research field, it’s a great thing to get published in a journal with any impact factor at all; and you shouldn’t worry about avoiding a journal just because it doesn’t have an impact factor, or if it’s fairly low.  At the same time, if you can get into a journal with an impact factor of 1 or above that’s a great achievement, and something that’s likely to make your supervisor(s), if they’re co-authors on the paper (see below), very happy.

 These days, the impact of a journal may also be reported in terms of its quartile: so from Q1 to Q4.  Essentially Q1 journals are those with impact factors within the top 25% of the subject area, and down to Q4 journals which are in the lowest 25%.  

General counselling and psychotherapy research journals

If you’re thinking of publishing in a general therapy research journal, one of the most accessible to get published in is Counselling Psychology Review – particularly if your work is specific to counselling psychology.  The word limit is pretty restrictive though.  If you’re coming from a more constructionist perspective, a journal like the European Journal of Psychotherapy & Counselling might also be a good first step, which publishes a wide range of papers and perspectives.

 For UK based researchers, two journals that are also pretty accessible are Counselling and Psychotherapy Research and the British Journal of Guidance and Counselling.  Both are very open to qualitative, as well as quantitative studies; and value constructionist starting points as well as more positivist ones.  The editors there are also supportive of new writers, and know the British counselling and psychotherapy field very well.

 Another good choice, though a step up in terms of getting accepted, is Counselling Psychology Quarterly.  Although it doesn’t have an impact factor, it has a very rigorous review process and publishes some excellent articles: again, both qualitative and quantitative.

 Then there’s the more challenging international journals, like Psychotherapy Research, Psychotherapy, and the Journal of Counseling Psychology, with impact factors around 3.  They’re all US-Based psychotherapy journals, fairly quantitative and positivist in mindset (though they do publish qualitative research at times), and if you can get your research published in there you’re doing fantastically.  Like a lot of the journals in the field, they’re religiously APA in their formatting requirements, so make sure you stick tightly to the guidelines set out in the APA 6th Publication Manual.  A UK-based equivalent of these journals, and relatively open to qualitative research (albeit within a fairly positivist frame), is Psychology and Psychotherapy, published by the BPS.

 There’s even more difficult ones, like the Journal of Consulting and Clinical Psychology with an impact factor of 4.5, and The Lancet is currently at 53.254.  But the bottom line, particularly if you’re a new researcher, is to be fairly realistic.  Having said that, there’s no harm starting with some of the tougher journals, and seeing what they say.  At worse, they’re going to reject your paper; and if you can get to the reviewing stage (see below), then you’ll have a really helpful set of comments on how to improve your work. 

 If a journal requires you to pay to publish your article, it’s often a scam.  So watch out for emails which, once you’ve completed your thesis, tell you how wonderful your work is and how much they want you to publish it in their journal—only to find out later that they charge a fortune for it.  There are some exceptions to this, and some reputable journals—particularly online ones that publish papers very quickly, like Trials—that you do need to pay a fee for.  But that’s only for very specific kinds of academic publication and should never be needed for normal research work.  At least not currently.  

Writing your paper

So you know what you’re writing and who for, now you just have to write it.  But how do you take, for instance, your beautiful 30,000 word thesis and squash it down to a paltry 6,000 words?

 If you’re trying to go from thesis to article, the first thing is that, as above, you can’t just cut and paste it together.  You need to craft it: compiling an integrated research report that is carefully knitted together to make a coherent whole.  It’s an obvious thing to say, but the journal editors and reviewers won’t have seen your thesis, and they’ll care even less what’s in it.  So what they’ll want is a self-contained research report that stands up in its own right—not referring back to, or in the context of, something they’ll never see.  That’s particularly important to bear in mind if you’re writing two or more papers from your research: each needs to be written up as a self-contained study, with its own aims, methods, findings, and discussion.

 In writing your paper, try and precis the most important parts of your thesis in relation to the question(s) that you’re asking.  Take the essence of what you want to say and try and convey it as succinctly and powerfully as possible.  Think ‘contracting’ or ‘distilling’: reducing a grape down to a raisin, or a barley mash down to a whiskey—where you’re making it more condensed but retaining all the goodness, sweetness, and flavour.  That doesn’t mean you can’t cut and paste some parts of your thesis into the paper, but really ask yourself whether they can be condensed down (for instance, do you really need such long quotes in your results section?), and make sure you write and rewrite the paper until it seamlessly joins together.

Your results are generally the most important and interesting part of your paper, so often the part you’ll want to keep as close to its original form as possible.  So if you’ve got, say, 7,000 words for your paper, you may want your results to be 2-3,000 of that (particularly if it’s qualitative).  Then you can condense everything else down around it.  Your introduction may be reducible to a paragraph or two; your literature review maybe 500-1,000 words.  Maybe 1,000 words for your methods and discussion sections; 1,000 words for references. 

 If you’ve written a thesis, you may be able to cut some sections entirely.  If you’re submitting to a more positivist journal, your reflexivity section can often just go; equally your epistemology.  Sorry.  If your study is qualitative, you may also find that you can cut down a lot of the longer quotes in your results.  Again, try and draw out the essence of what you are trying to say there… and just say it.

 Generally, and particularly for the higher-end US journals, you’re best off following the structure of a typical research paper (and often they require this): background, methods, results, discussion, references. They’re may be more latitude with the more constructionist journals (such as the European Journal of Psychotherapy & Counselling) but, again, check previous papers to see how research has been written up. 

 Make sure you write a very strong abstract (and in the required format for the journal).  It’s the first thing that the editor, and reviewers, will look at; and if it doesn’t grab their attention and interest then they may struggle with the rest of the paper.  There’s some great advice on writing abstracts in the APA 6th Publication Manual (Section 2.02) as well as on the internet (for instance, here).  

Supervisors and consultants

If you’ve had a supervisor, or supervisors, for your research work, there’s a question of how much you involve them in your publication, and whether you include them as co-author(s).  At many institutions, there’s an expectation that, as the supervisor(s) have given intellectual input into the research, they should be included as co-author(s), though normally only as second or third in the list.  An exception to the latter might be if a student feels like they don’t want to do any more work at all after they’ve submitted their thesis, in which case there might be an agreement that one of the supervisors take over as first author.  Here, as with any other arrangement, the important bit is that it’s agreed up front and everyone is clear about what’s involved. 

 Just to add, as a student, you should never be pressurised by a supervisor into letting them take the first author role.  I’ve never seen this actually happen, but have heard stories of it; and if you feel under any coercion at all then do talk to your Course Director or another academic you trust.

 The advantage of keeping your supervisor(s) involved is that they can then help you with writing up for publication, and that can be a major boost if they know the field and the targeted journal well.  So use them: probably, the best way of getting an article published in a journal is by co-authoring it with someone who’s already published there.  A way that it might work, for instance, is that you have a first go at cutting down your thesis into about the right size, and then the supervisor(s) work through the article, tidying it up and highlighting particular areas for development and cutting.  Then it comes back to you for more work, then back to your supervisor(s) for checking, then back to you for a final edit before you submit.  

How do you submit?

That takes us to the process of submitting to a journal.  So how does it work?  Nearly all journals now have an online submission portal so, again, go to the journal website and that will normally take you through what you need to do.  Submission generally involves registering on the site, then cutting and pasting your title and abstract into a submission box, entering the details of the author(s) and other key information, and uploading your papers.  The APA 6th Publication Manual has some great advice on how to prepare your manuscript so that it’s all ready for uploading, and if you follow that closely you should be ok for most journals.

You also normally need to upload a covering letter when you submit, which gives brief details of the paper to the editor.  This can also cover more ‘technical’ issues, like whether you have any conflicts of interest (have you evaluated, for instance, an organisation that you’re employed by?), and confirmation of ethical approval.  If you’ve submitted, or published, related papers that’s also something you can disclose here.  Generally, it’s fine to submit multiple papers on different aspects of your thesis, but they should be different; and it’s always good just to let the editor know so that it doesn’t come as a surprise to them later. 

Note, you definitely shouldn’t submit the same paper (or similar papers) to more than one journal at any one time.  Of course, if your paper gets rejected it’s fine to try somewhere else (see below), but you could get into a horrible mess if you submitted to more than one journal in parallel (for instance, what happens if they both accept it?). So most journals ask you, on submission, to confirm that that’s the only place you’ve sent it to and that’s really important to abide by.  

What happens then?

The first thing that normally happens is that a publishing assistant will then have a quick look over your article to check that it’s in the right format.  As above, they can be pretty sticky here, and if you’re over the word limit, or not doing the right paragraph spacing, or even indenting your paragraphs when you shouldn’t, you can find your article coming back to you asking for changes before it can be considered.

Then, when it’s through that, it’s normally reviewed by the journal editor, or a deputised editor.  Here, they’re just getting a sense of whether the article is right for the journal, and at about the required level.  Often papers will get rejected at that point, with a standard email saying that they get a lot of submissions, they can’t review everything, it’s no comment on the quality of the paper, etc., etc.  Pretty disappointing—and generally not much more feedback than that.  Ugh!

If you don’t hear from the journal a week or so after submission, it generally means it’s then got through to the next stage, which is the review process.  Here. the editor will invite between about two and four experts in the field to read the paper, and give their comments on it.  This process is usually ‘blind’ so they won’t know who you are and you won’t know who they are.  In theory, this helps to keep the process more ‘objective’: the reviewers aren’t biased by knowing who you actually are, and they don’t have to worry about ‘come back’ if they give you a bad review.  

The ‘decision letter’

Assuming the paper has gone off for review (and if you don’t hear anything at all from for a few months it’s fine to check what’s happening), you’ll get a decision letter from the editor.  Generally, this gives you the overall decision about acceptance/rejection, a summary from the editor of comments on your paper, and then the specific text of the reviewers’ comments.

In terms of the decision itself, the best case scenario is that they just accept it as it is.  But this is so rare, particularly in the better journals, that if you ever got one (and I never have), you’d probably worry that something had gone wrong with the submission and review process.

Next best is that they tell you they’re going to accept the paper, but want some revisions.  Here, the editor will usually flag up the key points that they want you to address, and then you’ll have the more specific comments from the reviewers.  Sometimes, journals will refer to these as ‘minor revisions’, as opposed to more ‘major revisions’, but often they don’t use this nomenclature and just say what they’d like to see changed.  Frequently, they don’t even say whether the paper has been accepted or not—just that they’d like to see changes before it can be accepted—and that can be frustrating in terms of knowing exactly where you stand.  Generally, though, if they don’t explicitly use the ‘r’ word (‘reject’), it’s looking good.

Then you can get a ‘reject and resubmit’. Here, the editor will say something like, ‘While we can’t accept/have to reject this version of the paper, due to some fairly serious issues or reservations, we’d like to invite you to resubmit a revision addressing the points that the reviewers have raised’.  In my experience, about 50% of the time when you resubmit a rejected paper you eventually get it through, and about 50% of the time they subsequently reject it anyway.  The latter is pretty frustrating when you’ve done all that extra work, but at least you’ve had a chance to rework the paper for a submission elsewhere. 

Then, there’s a straight rejection, where the editor says something fairly definitive like, ‘…. your paper will not be published in our journal.’  That’s pretty demoralising but, at least, if you’ve got to this stage, you’ve nearly always got some very helpful feedback from experts in this field to help you improve your work.

Emotionally, the editorial and reviewing feedback can be pretty bruising, especially when it’s a rejection.  Reviewers don’t tend to pull punches: they say what they think—particularly, perhaps, because they’re under the cover of anonymity.  So you do need to grow a fairly thick skin to stick with it.  Having said that, a good reviewer should never be diminishing, personal, or nasty.  Even when rejecting a submission, they’ll be able to highlight strengths as well as limitations, and to encourage the author to consider particular issues and pursue particular lines of enquiry, to make the best of their work and their own academic growth.  So if something a reviewer says is really hurtful, it’s probably less about the quality of your work, and more about the fact that they’re being an a*$e (at least, that’s what I tell myself!).

By the way, sometimes, quite quickly after you’ve started to submit papers (and possibly even before), you may be asked to review for the journal yourself.  That can be a great way of getting to know the reviewing process better—from the other side.  It’s also part of giving back to the academic community: if people are spending time looking at your work, it’s only fair you do the same.  So do take up that opportunity if you can.  There’s some very helpful reviewer guidelines here.  

Revising and resubmitting

If you’re asked to make revisions, journals will generally give you six months or so—less if they’re relatively minor.  Here, it’s important to address every point raised by each of the reviewers.  That doesn’t mean you have to do everything they ask for, but you do have to consider each point seriously, and if you disagree with what they’re saying, you need to have a good reason for it.  Generally, you want to show an openness to feedback and criticism, rather than a defensive or a closed-minded attitude.  If the editor feels like they’re going to have to fight with you on each point, they might just reject the paper on resubmission.

As well as sending back the revised papers, you’ll need to compile a covering letter indicating how you addressed each of the points that the reviewers’ raised.  You may want to do this as a table as you go along: extracting each of the reviewers’ points, and then giving a clear account of how you did—or why you did not—respond to that issue.

Pay particular attention to any points flagged up by the editor.  Ultimately it will be their decision whether or not to accept your paper, so if they’re asking you to attend to some particular issues, make sure you do so. 

Resubmissions go back through the online portal.  If the changes required are relatively minor, it may just be the editor looking over them; anything more substantive and they’ll go back to the reviewers again for comment.  Bear in mind that the reviewers are often the original ones who looked at your paper, so ignore their comments at your peril.

It’s not unusual to have three or four rounds of this review process: moving, for instance, from a ‘revise and resubmit’ to ‘major revisions’ to ‘minor changes’.  At worst, it can feel petty and irritating; but, at best, and far more often, it can feel like a genuine attempt by your reviewers to help you improve the paper as much as possible.  The main thing here is just to be patient and accept that the process can be a lengthy one.  If you’re in a rush and just desperate to get something out whatever it’s quality, you’re going to be profoundly frustrated—unless you’re prepared to accept publication in a journal of much lower quality.  

Trying elsewhere

If your paper gets rejected, your choices are (a) just to give up, (b) resend the paper as is it somewhere else, or (c) make revisions based on the feedback and then resubmit elsewhere.  There’s also, of course, a lot of grey areas between (a) and (b) depending on how many changes you feel willing—and able—to make.  Generally, if you can learn from the feedback and revise your paper that’s not a bad thing, and can help form a stronger submission for next time.  Of course, it is always possible that the next set of reviewers will see things in a very different way; and sometimes changes made to address one set of concerns will then be picked on by the next set of reviewers as problems in themselves.  As for (a), well, I promise you this: if the research is half-decent, then you can always get it published somewhere—bear in mind that, if you’ve been awarded a doctorate for your research, it’s publishable by definition

Generally, when people get their papers rejected, they move slowly down the impact hierarchy: so to journals that might be more tolerant of the ‘imperfections’ in your paper.  But there’s no harm in trying journals at a similar level of impact when you’re trying somewhere else, particularly when you really don’t agree with the rejecting journal’s feedback.

Ultimately, it’s about persistence.  To repeat: if you want to get something published, and it’s half-decent, you will.  But it needs resilience, responsiveness, and a willing to put up with a lot of knockbacks.   

Other pathways to impacts

Journals aren’t the only place where you can get your research out to a wider audience and make an impact.  For instance, you could write a synopsis of your thesis and post it online: such as on Researchgate.  You won’t get as big a readership as in an established journal, but at least it will be more accessible than your university library, and you can tell people about it via social media.  Or you could do a short blog about your research, or make a video, or talk to practitioners and other stakeholders about your work.  If you want to make your research findings widely accessible to practitioners, you could also write about them for one of the counselling and psychotherapy magazines, like BACP’s Therapy Today or BPS’s The Psychologist.   

There’s also many different conferences that you can go to to present your findings: as an oral paper, or simply as a poster.  Two of the best, for general counselling and psychotherapy research in the UK, are the annual research conference of the British Association for Counselling and Psychotherapy (BACP), and the annual conference of the BPS Division of Counselling Psychology (DCoP).  Both are very friendly, encouraging, and supportive; and you’ll almost certainly receive a very warm welcome just for having the courage to present your work.  At a more international level is the annual conference of the Society for Psychotherapy Research (SPR).  That’s a great place to meet many of the leading lights in the psychotherapy research world, and is still a very friendly and supportive event. 

You can also think about ways in which you might want your work to have a wider social and political impact.  Would it make sense, for instance, to send a summary to government bodies, or commissioners, or something to talk to your local MP about?

Of course, this could all be in addition to having a publication (rather than instead of it), but the main point here is that, if you want your research to have impact, it doesn’t just have to be through journal papers.  

To conclude…

When you’ve finished a piece of research—and particularly a long thesis—often the last thing you’ll want to be doing is reworking it into one or more publications.  You can’t stand the sight of it, never want to think about it again—let alone take the research through a slow and laborious publication process.  But the reality is, as people often say, the longer you leave it the harder it gets: you move away from the subject area, lose interest; and if you do want to publish at a later date, you’ll have to re-familiarise yourself with all the latest research (and possibly without a library resource to do so).  So why not just get on with it, get it out there; and then you can have your work, properly, in the public domain, and people can use it and learn from it, and improve what they do and how they do it.  And then, instead of spending the next few decades wishing you had done something with all that research, you can really, truly, have the luxury of never having to think about it again.

The Viva: Some Pointers

The following pointers are for doctoral trainees in the counselling, psychotherapy, and counselling psychology field to help you get through your viva.  Please note that they are specific to the UK, and that the viva process can be very different in other countries.  This is particularly true for vivas in continental Europe, where it tends to be more of a ratification, and public confirmation, of what a PhD team have already decided.  Here, in the UK, the viva panel really does decide on the outcome of your work.

Many thanks to Jasmine Childs-Fegredo, Mark Donati, and Edith Steffen for comments and suggestions.

 ***

For doctoral students, the viva is the endpoint of your academic journey, and can be the most dreaded part.  So what is it, and what should you do to make it go as well as possible?

The Set Up

Typically, you’ll have two examiners: an ‘internal’ (someone based at your university), and an ‘external’ (someone based at another university).  The external usually carries more weight, and may have more influence on the final decision.  You may also have a ‘Chair’ (normally someone based at your university as well), but their role will just be to manage the viva examination.  They don’t have a role in assessing you.

 Often, you can choose whether or not to have your supervisors present at the viva, though they won’t be able to say anything.  This can feel like moral support, and they can take notes on what might need to be revised.  However, you may also feel more pressure having additional people in the room.

Typically, a viva lasts for about 90-120 minutes, though that can vary a lot.  If longer, you’ll normally get a short break.

What viva examiners often do is to go through your thesis chapter by chapter, asking questions and discussing with you aspects of your work along the way.  Sometimes your examiners will take it turns to ask questions, or the external may take more of a lead.  However, this can depend on the examiners’ areas of expertise.  For example, if your external knows more about your methods, and your internal more about your content area, they may divide the questions up in that way.

Prior to the viva, both of your examiners will have read through your thesis, and written an independent report of what they make of it, and approximately what outcome they think you should be awarded.  In the vast majority of cases, this will be either ‘minor amendments’ (for instance, adding more on reflexivity, discussing the limitations in more depth) or ‘major amendments’ (for instance, restructuring the literature review, revising the analysis).  In a small number of cases, they may also feel that you need to collect more data—a very major amendment.  It’s also possible that they’ll feel the thesis should fail but, thankfully, that’s very rare, and something that your supervisors would normally alert you to before you submit.  Equally rare is that the examiners will just pass your thesis without wanting to see any changes at all, so it may be best to go into the viva assuming that the examiners will ask you to make revisions to some degree—even if it’s just correcting typos.  Before they meet you, your examiners will also have met with each other and shared their views on your thesis, coming up with a list of questions to structure the viva by.

Your examiners may start by telling you their overall assessment of your thesis, or they may not.  If this doesn’t happen, don’t read anything into it—some examiners just prefer not to do so.

After they’ve talked your thesis through with you, the examiners will ask you to leave the room (for 30 minutes or so), and then they’ll discuss with each other what they think the outcome should be and what changes they think you should make.  Then they’ll invite you back in and share the result with you.  If, as normal, they’re asking for some amendments, they’ll go through them with you but you won’t need to write them down, as you’ll be sent the feedback in writing soon after the viva.

What’s it For?

As an external examiner, what I’m wanting from the viva is three things.  First, I want to make sure that the student has really written their thesis, and not got someone else in to do it for them.  So that means I’m looking to see that they can talk about their work in a fairly fluent and knowledgeable way.  Second, although I’ll come into the viva with an outcome in mind and some idea of the kinds of amendments that I might want to see, I’m also open to revising that, depending on how the candidate talks about their work.  For instance, I might feel that they should have conduct a systematic literature review rather than a narrative one, but if they present a convincing argument for why they did the latter, then I may be happy to let that go.  Third, I might want to convey—and explain—to the student why I think they should make certain changes to their thesis, and what those changes are.  

 Remember that your examiners, like your supervisors, will almost certainly want to see you get through.  No one wants to fail anyone—we all know how much work a thesis takes.  But we also will want to make sure things are fair: if it feels like you haven’t got your head around certain things, or done the work that you’ve needed to do, then it wouldn’t feel right to pass you alongside others.  And we’re also aware that your thesis will be lodged publicly, for all to access and read.  So we want to see it in the best shape possible: something you can be proud of and that reflects the best of your abilities.

How to Prepare

Before the viva, have a really good few read throughs of your thesis so that you know it well.  You may have completed it several months before the viva, so it’s important to re-familiarise yourself with it—particularly the more tricky or complex parts.

Practice vivas are essential.  Your supervisor(s) will often be willing to do this with you.  If not, or as well as, do practice vivas with your peers or friends.  Get them to ask you questions about your thesis—particularly the more difficult bits (like epistemology, or your choice of methods, or any statistical tests) so you can get practised at talking these elements through.  Talk to your friends, your family, your cat about your thesis (as much as they can bear it) so that you’re really familiar with what you did and why.

What to Take to the Viva?

One of my personal bugbears, as an examiner, is when students come to a viva without a copy of their own thesis, and then have to borrow mine to answer questions.  So make sure you bring yours along, with sections clearly marked so you can find your way around it when asked about different parts.  It’s fine also to bring a notepad so you can write down questions.

Nerves

It can be really scary doing a viva, and your examiners should be well aware of that and sensitive to it—bear in mind that they will have gone through one of their own.  So if you get really nervous at the start or during the viva, it’s normally fine to ask for just a bit of time to compose yourself—there’s no rush. You may even want to let the Chair or examiners know at the start, if you think that will help. 

What Will They Ask Me?

Mostly, the questions that your examiners will ask will be specific to your particular thesis.  As indicated above, typically, they’ll go through it chapter by chapter, and ask you to explain, or elaborate on, specific aspects of your work.  The questions will often be on the areas that they feel might need further work.  However, if they feel that really not much needs to be changed, they may just be asking about particular areas of interest to discuss them with you.  After they’ve asked you about a particular area of issue, they may follow this up with further questions or prompts.  Questions may be fairly general (for instance, ‘Can you explain your choice of analytical method?’) or very specific (for instance, ‘On page 125, you indicate that the p-value was .004, but on page 123 you write that the regression analysis wasn’t significant, can you explain that please’).  There’s also some standard questions that examiners may ask, for instance:

  •  Why did you choose to do this study?

  • How did you go about choosing what literature to look at?

  • What was the underlying epistemology for your research?

  • What was the rationale for your sample?

  • Why did you choose this particular method?  Why not xxx method?

  • What are the implications for counselling/psychotherapy/counselling psychology practice of your thesis?

  • What does your research add to the field?

  • What are the limitations of your study?

  • What was the impact of your personal perspective on the study? Biases?

  • What did you personally learn from the study?

Elaborate, Elaborate, Elaborate

In terms of the actual viva, the main bit of advice I would give candidates is to make sure you really elaborate on your answers.  Of course, you want to stay on track with the particular question you’ve been asked, but don’t be too short or pithy in how you respond.  For a typical viva, the examiners may have prepared, say, 10 questions or so, so you need to talk on each area for, perhaps, 10 minutes; and you don’t want a situation where your examiners are constantly having to pump you for answers.  This is your chance to show your depth and breadth of thinking so, for instance, reflect with the examiners on why you made the choices you did, show how you weighed up different possibilities, talk about the details of what you considered and what you found.  Ultimately, what your examiners want to see is that you can think deeply and richly and complexly about things—rather than that you have reached any single definitive conclusions.  So it’s less about getting it ‘right’, and more about showing all the thinking that has been going on. 

Don’t be Defensive

The other main thing I would say is not to be too defensive when you respond to the examiners’ questions and prompts.  As indicated above, they’ll have a view on what they may want you to revise in your thesis, and while you may be able to change their minds to some extent, you don’t want to come across as too rigid or stubborn in your thinking.  If, when they point something out to you, you think, ‘Actually, they’re probably right,’ that should be fine to say, and better than trying to defend something that you can clearly see is in need of adjustment.  Of course, if you think you’re right, do say it and say why, but you don’t have to defend to the bitter end every element of your work.  Better to show, like all of us, that you can sometimes get things wrong and that you’re open to learning and improving.

Be the Expert You Are

As Mark Donati, Director on our Doctorate in Counselling Psychology at the University of Roehampton suggests, don’t be afraid to express your opinion and say what you really think.  Of course, it’s best if this is based on the available evidence; but sometimes the evidence just isn’t available, and then the examiners may be really interested in your ‘best guess’ of what’s going on.  Remember that you are the expert in the area now.  That’s right, you are.  And the examiners may be really excited to hear from you what the view is from the leading edge of the field. 

Don’t Shame your Examiners

That might sound strange to say, but bear in mind that your examiners are also in a social situation, and may be experiencing their own pressures to ‘perform’.  Dr X, for instance, has come down from University Y, and it’s the first time they’ve met your internal examiner Professor Z, whose work they’ve always admired, as well as Chair W, who they don’t know very well but who seems an important figure.  So Dr X wants to show that they’ve got a good understanding of your work, with some intelligent questions to ask, and some good insights about the field.  What that means is, if you want to keep your examiners ‘on side’, treat them with respect and show an interest in what they’re saying and the questions they asked.  You really don’t want to respond to Dr X in a way that may make them feel foolish in front of Professor Z, or like they have to defend themselves.  What this also means is that some of what goes on in the room may not be about you, but also about the dynamics between the rest of them. 

Enjoy

It’s easier said than done, but if you can enjoy your viva (and many students do end up doing so) then that’s great.  Think of it this way: you’ve got a captive audience for two hours who you can talk to about all the work you’ve been doing for the last few years.  And now you’re the expert, so make the most of it: tell them about what you’ve been really thinking, and about some of the complex challenges doing the thesis, and about all your ideas about where the research should go for the future.  It’s your chance to shine, and if you can really connect with your energy and enthusiasm for your work, your examiners are sure to appreciate that—and so might you.

How do you get a therapy book published?

So you’ve got a great idea for a book in the counselling and psychotherapy field. You’re all excited. You want to write. What do you do next to turn your idea into a fully-fledged publication? 

Who’s it for?

That’s great you’ve got an idea. But a lot of what you need to do is to turn things on their head and ask yourself, ‘Who’s going to want this book?’ Unfortunately, all the excitement and passion we can feel inside ourselves doesn’t necessarily translate into a viable book for a publisher. Their first question is going to be, ‘Who’s going to want to buy this?’ So you really need to be clear about that. Is it for trainees? Is it for practitioners? On person-centred courses? On integrative courses? And you need to be realistic here. Bear in mind that people have hundreds of books on their ‘to buy’ list, so why would they want to buy yours? A book that is targeted towards trainees is likely to be particularly appealing to publishers, because that tends to be their biggest market. And if it’s the kind of thing that would be a core text on a module reading list, bingo, that’s exactly the kind of thing that many publishers will be looking for. 

What else is out there?

You need to know the field. What other kind of books are like it? If there’s something out there similar, that doesn’t necessarily mean that yours is a no goer, but you need to make it clear to the publishers what the unique selling point (USP) of your book is going to be. Maybe it’s more accessible than the previous texts. Maybe it’s for work with children rather than adults? But you need to clearly state to the publishers why your book will fill a gap in the market that isn’t currently filled. And that means more than just quoting what you’re already aware of. It means doing some research on sites like Amazon or Google to have a really good rummage around to find out what’s out there so far.  

What have you written before?

Publishers will want to be reassured that you can write. If you’ve written articles or journal papers before, that’s great; and a book or two will really convince a publisher that you’re going to produce what you say you will. If you’ve never written before, a book is a tough place to start, and you’re probably better off writing and submitting a few articles first—say for Therapy Today—to get a sense of how you feel about writing and what kind of feedback you get. Anyone, I’m sure, can write brilliantly, but believing we can write brilliantly isn’t the same as actually doing it. It requires the ability to be able put things in clear and succinct ways. And, more than anything else I think, it requires the kind of dogged, slightly OCD personality that is determined to go on and on even when you’re exhausted and tired and just want a glass of wine and sleep. If you’re not sure that’s you, then best to find out first. 

co-authored and edited BOOKS

Writing a book with one or more other colleagues can be a great way to take a project forward: not only do you split the work, but you can get to have some great dialogues along the way. The obvious thing to say, though, is to make sure that you really do get along and you’ve agreed the basics of who’s doing what, etc. You really don’t want to get halfway through the book and discover that you’ve got completely different ideas about how it should end up, or your co-author’s moved to Goa and wants to spend the rest of their life doing yoga instead of writing.

You may also be thinking about putting together an edited collection of chapters on a particular topic. Again, that does split the work and means that you don’t have to know everything yourself; but don’t underestimate the effort of identifying, then editing, a whole series of chapters—and liaising with 10-20 authors along the way. Sometimes, when I’ve done that, it’s felt like it would have been easier to write the whole thing myself! Also, publishers don’t tend to like edited books as much as single or co-authored texts. They’re not usually as coherent, or as flowing, and generally they don’t sell as well. So if you do go down that route, I’d suggest taking a strong editorial lead, to make sure that everyone is writing to the same brief and same overall aims.

Which publisher?

There’s lots of different publishers out there in the counselling and psychotherapy field and you’ll need to decide which one to approach first. It’s ‘bad form’ to approach more than one publisher at any point in time, so you’ll need to start with one and, if they don’t like it, go on to another, etc. To find the right publisher, have a look at similar books in the field and see who they are published by. You may want to start there. If it’s a general counselling or psychotherapy textbook, particularly for trainees, Sage might be a great place to start. If it’s a bit more specialised, and particularly related to person-centred therapy or critical perspectives, PCCS Books could a very good choice. Routledge have a very wide ranging list and tend to publish a bit more academic, and specialised, books than Sage. And then there’s many others—like Palgrave, Open University Press, Oxford University Press—all with their own areas of focus and speciality. If you’re not sure, just go to their websites and see what kinds of book they publish. Do any of these look like yours?

If you know people who have written books with these publishers, you may also want to have a chat with them to see how things went. Were they good to work with, were they reliable and timely? Is there a lot of staff turnover? My own books have been mostly with Sage, and I have to say that they have been brilliant to work with. Not just professional; but supportive, friendly, and always encouraging. And they have the best parties (in fact, a colleague of mine recently wanted to publish with Sage just so that she could get invited!). I’m also very fond of PCCS Books and would definitely recommend them as a publisher to consider approaching. They’re a lot smaller than Sage, but have a real dedication to the books that they publish and care about the counselling and psychotherapy field very deeply. That makes a real difference when you feel like you are writing with a publisher that cares about the field—not just in it for the money.  

Write the proposal

Then you need to write a proposal. This is, perhaps, 10 pages or so, in which you describe what the book is, who it is for, a synopsis of chapters, and a CV, etc. I remember writing my first book proposal back in about 1988, and the mum of one of my friends, who had published with Penguin, made the point (very nicely) that if the writing in the proposal was that bad, how were the publishers ever going to think I could write a good book! So spend some time crafting the proposal and showing, straight away, that you can write.

Importantly, a lot of publishers will have their own format that they want proposals in. For instance, check out the Sage guidelines here. Even if you don’t want to publish with Sage, that will give you some great ideas about the kinds of things you need to cover in your proposal.

Generally publishers will want to see some examples of your writings. Again, send in something that reflects the kind of thing you want to write in the book. if you don’t have that yet, you may want to spend some time developing it before you write your proposal—just so you can show to yourself, as well as the publisher, that you can and do want to write in that way.  An example chapter or two can be a great thing to show to the publisher that the book can really work.

Of course, you could always write the book first and then send the whole manuscript to a publisher, but that's not always appreciated by publishers and can lead to a lot of wasted effort. Usually, publishers want to be involved in the development of a book, and will have a lot of good ideas about how to orientate it to their market.

Do I need an agent?

In this field, almost certainly not. If you think you’ve got a brilliant idea for a best selling ‘pop psych’ book, say for Penguin, then you may want to find a literary agent (you can search on the internet), but the amount of money in psychotherapy and counselling books means that it’s generally not worth it. And, yup, that’s right, not much money. So if you’re thinking that writing books in counselling and psychotherapy is going to make you your fortune, you’ll need to look elsewhere!

What next?

If the publishers think your proposal may be of interest to them, what they’ll then do is to send it out to some reviewers to see what they think, and to get feedback. You normally hear back in a few months. It’s not unusual to get rejected, particularly if you haven’t written before, and, of course, the thing is not to get demoralised but to learn from the feedback and see how you can revise your proposal for the next publisher.

If the publishers do want to take the book on, they’ll then send you out a contract to sign with various financial and timescale agreements. These are normally pretty straightforward, but a key thing to check is the royalties—that is, how much of the book sales you actually get. Normally, this starts off around 7%, so if a book sells for around £25, you’ll get about £2 per book. If you haven’t seen or signed one of these contracts before, try and see if there’s someone you know who has who can have a quick look over it and just check that it all looks OK.

Do I have to have an established publisher?

Absolutely not. There’s many ways to publish a book now that don’t involve going through the traditional route. It’s very easy, for instance, to do some self-formatting and then publish the book on your own website. Or just write the book as a series of blog posts. And that could be a good way of building up to a publication through more established routes over time. For instance, with my latest book on Integrating counselling and psychotherapy, I’d started off just writing a 20,000 word monograph to get the ideas out, and I put them on the internet. It was only several years later that I came back to this and fleshed it out into a full, 110,000 word text.

Is it all worth it?

Hm… 

 I couldn’t say it any other way than, for me, it’s an absolute bastard writing books. It’s a massive amount of work, commitment, focus, struggle—intellectually and emotionally. There’s time when I’ve felt completely out at sea, out of my depth, drowning. I’ve hated the book, hated myself for thinking I could write it, hated the whole process of sitting down for hours a day and trying to scratch out something of a meaning. But when you get that book finally in your hands, or when people say to you things like, ‘Ah, that book you wrote really helped me,’ or, ‘it made such a difference to my work,’ it does feel incredibly rewarding. Personally, I feel like, if I hadn’t of written, my life would feel so much more impoverished: I had so many things I wanted to say, and having that out there, in the public domain, forever, feels an amazing privilege. And it does make me want to say more things, to write more, to continue and deepen that dialogue with the world. So, yes, I guess, definitely worth it. Absolutely. But that’s just for me. And working out whether, for you, the pros are really worth the cons is, perhaps, the first step in the whole process.

 Very best of luck with it.

Presentations: Some Pointers

The following suggestions are for students, practitioners, or academics delivering conference or seminar presentations—quantitative or qualitative—in the psychological therapies: including counselling, psychotherapy, and counselling psychology.  It was developed in collaboration with doctoral students on the University of Roehampton Doctorate in Counselling Psychology.

 A great short video about all the things to avoid when presenting can be found here.

 Prepare… prepare… prepare…

  • Know your timing: check that the length of your presentation fits into the allocated time slot. Be particularly wary of having much too much material for the time available.  Keep an eye on the time during your presentation and, if helpful, write on your notes where you should be up to by particular points, so you know if you need to speed up/slow down.

  • Practice your slides to get a good feel for them, and so you know what’s coming next.

  • Turn up to the room early and check your slide show is uploaded and works. Know the pointer, how to change slides, etc. Technological issues are often the biggest saboteur of a good presentation.

  • If, like many of us, you get anxious doing talks, think about how you could manage that. For instance, do you need things written out in detail to ‘fall back on’, or have breathing techniques ready if you get panicky?

 Slides

  • Keep the lines of texts per slide to a minimum. Generally no more than six lines per slide. If you have more to say, do more slides.

  • Font size shouldn’t normally be less than 30 points, and definitely not less than 20 points.

  • Texts should be bullet points, rather than full sentences.

  • Be consistent in your formatting: e.g. fonts, type of bullets, colour of headings.

  • If you have text on your slides, talk ‘to’ it. Don’t have text on the slide that you never refer to.

  • Use the space on the slides—make text large rather than small text squashed away.

  • Generally, sans serif fonts (e.g., Arial, Tahoma, Century Gothic) are more suited to presentations than serif fonts (e.g., Times New Roman, Palatino). NCS: Never Comic Sans!

  • Try to use images/graphics wherever possible, ideally each slide.  You can also embed videos (but check sound works before your presentation). Images and videos can be a great way of conveying the reality of your research: for instance, a photo of the room where the interview took place, or a short video of you doing the coding (bear in mind confidential, of course).

  • Diagrams can be really helpful, but make sure you spend time talking them through and explaining what different elements mean. Don’t just leave it up to your audience to work it out for themselves.

  • Don’t make slides too complex/‘flashy’: for instance, transition sounds.  Everyone hates transition sounds!

  • For a research presentation, it’s generally fine to use the ‘normal’ headings of a paper to structure your talk: Introduction (including literature review), Methods, Results, Discussion.  Headings can be on separate slides to keep the sections really clear.

  • Give clear titles to each slide so that the audience know what you are trying to say.

  • Don’t scrimp on presenting your results: they’re often the most important and interesting part of your paper, so ensure you leave a proper amount of time to talk through them (say 50% of your overall time, if a qualitative presentation).

  • If you’re discussing a key text, give a reference so that your audience can follow up.

  • Everyone users Powerpoint—think about trying Prezi.

  • Watch copyright—you shouldn’t use images that aren’t in the public domain. You can find many images that are available for reuse via Google Search/Images/Settings/Labelled for reuse.

 Connect with your audience

  • Lead your audience through your talk.  You may be really familiar with your material, but they are unlikely to be.  So explain things properly: from why you did your research, to what your findings mean, to what it says, ultimately, about clinical practice.

  • Know who your audience is and adjust accordingly.  For instance, a group of experienced practitioners may know, and want, very different things from a group of early stage researchers. Think about what your audience will want from the talk.  And what they might already know (that you don’t need to repeat)?

  • Talk to your audience. Try to connect with them. Breathe, focus, speak to the people in the room. Don’t just rattle through your speech.

  • Try to connect with the ‘story’ of what you are saying: if it’s meaningful to you it’s more likely to be meaningful to your audience.

  • Remember that, nearly always, your audience are there to learn from you—not to judge you. So the question is not ‘How can I prove I’m good enough?’ but, ‘What can I teach these people?’

  • Try not to read directly from your notes, or from your slides. Best to use them as stimuli.

  • Avoid jargon or lots of acronyms.  Keep it as clear and easy to understand as you can.  If you need to use acronyms, explain clearly what they mean.

  • Speak loud and clear – check people can hear you, if need be, particularly at the back.

  • Watch that you’re not talking too fast, particularly if you’re anxious. Try the talk out with a friend/colleague and get some honest feedback from them.

  • Pace your talk, so that you have enough time for all of it. It’s a classic mistake to get very caught up in the first part of your talk, and then have to rush the rest (and often the most interesting bits).

  • Make sure you leave time for questions—so that you’re audience can really engage with you.

  • Don’t be defensive if asked questions: accept that there may be things to develop in your paper if you can see that.

  • It’s really bad form to run over time, as it means you’re eating into the next person’s allocated slot (or everyone’s coffee/lunch). So if you’re asked to stop, stop. 

  • It’s fine to bring yourself in to the presentation, and often that’s a way of helping the audience connect with you.  For instance, why did you, personally, want to do this study?  What did you, personally, get out of it?

  • Humour can be a great way of connecting, and cartoons can often lighten a talk and engage and audience. But don’t force humour if it’s not ‘you’.

  • And, finally, don’t stand in front of the projector!

The Discussion Section: Some Pointers

The following suggestions are for Master’s or doctoral level students writing empirical dissertations—quantitative or qualitative—in the psychological therapies: including counselling, psychotherapy, and counselling psychology.  It was developed in collaboration with doctoral students on the University of Roehampton Doctorate in Counselling Psychology

The pointers below are only recommendations, and from one particular perspective (midway-ish between a realist and social constructionist standpoint). Different trainers, supervisors, examiners, and methodologies may view these issues in very different ways.

  • The aim of a discussion section is to discuss what your findings mean, in the context of the wider field.

  • As with all other parts of your paper, make sure that your discussion is actually discussing the question that you set out to ask.

  • Make sure that your discussion section doesn’t just re-state your findings.

  • Generally, you shouldn’t be presenting raw data in your discussion section. That goes in your results. Here, you’re discussing the meaning of your results more generally.

  • Similarly, try to avoid referencing lots of new literature in your discussion section. If it’s so relevant, it should be there in your literature review.

  • Make sure that your discussion does, indeed, discuss your findings. It shouldn’t just be the second half of your literature review: something which bypasses your own research. Emphasise the unique contribution that your findings make, and focus on what they contribute to knowledge. Be confident and don’t underplay the importance of your own findings.

  • At the same time, don’t over-state the implications of your findings (particularly with regard to practice). Be realistic about what they mean/indicate, in the context of the limitations of your study, as well as its strengths.

  • This is your chance to be creative, exploratory, and to investigate specific areas in more detail, but try to ensure that it’s always grounded in the data: what you found or what others have found previously. So not just wild speculation.

  • What’s unexpected in your results? What’s surprising? What’s counter-intuitive? What’s anomalous? Your discussion is a great opportunity to bring these out to the fore more fully and explore them in depth.

    Typical sections of a discussion section (often in approximately this order)

  • Brief summary of your findings (but keep it brief – just a concise-but-comprehensive paragraph or two).

  • What your findings mean, in the context of the previous literature. So, for instance, how they compare with/contrast/confirm/challenge previous evidence and theory. This is also an opportunity for you to untangle, and to try and explain, complex/ambiguous/unexpected findings in more depth.

    • This would normally be the bulk of your discussion. It may be appropriate to structure this section by your research questions, or by the themes in your results. If you do the latter, though, as above, be careful that you’re not just reiterating your findings.

    • Remember that you don’t need to give equal weight/space to all your findings. If some are much more interesting/important than others, it’s fine to focus your discussion more on those; though all key findings should be touched on at some point in the discussion.

  • Limitations. This should be a good few paragraphs. Try to say how the limitations might have affected the results (e.g., ‘a volunteer sample means that they may have been more positive than is representative’) rather than just what the flaws in the study were, per se.

    • Be critical of what you did; but from a place of reflective, appreciative awareness, rather than self-flagellation. The point here is not to beat yourself up, but to show that you can learn, intelligently; just as you did something, intelligently.

  • Implications for clinical practice. Also, if relevant, implications for policy, training, supervision, etc.

    • Try to keep this really concrete: what would someone do differently, based on what you found.  So, for instance, not just, ‘These findings may inform practitioners that….’ But, ‘Based on these findings, practitioners should….’

  • Specific implications for your specific discipline: e.g., counselling psychology/counselling/psychotherapy.

  • Suggestions for further research.

  • Reflexivity: what have you learnt from the study, both in content and in practice.

  • Conclusion: this can be a brief statement bringing all your thesis together.

    Appendices

    Following your references, you are likely to want to append various documents to your thesis. These can include:

  • Participant-facing forms: e.g., information sheets, consent forms, adverts.

  • Full interview schedule.

  • Additional quantitative analyses and tables.

  • A transcript of one interview (but bear in mind confidentiality—this may not be appropriate). This could also show your coding of that interview.

  • All text coded under one particular theme/subtheme, for the reader to get a sense of how you grouped data together (again, bear in mind confidentiality).

(Image by Muhammad Rafizeldi, Creative Commons Attribution-Share Alike 3.0 Unported license)

The Results Section: Some pointers

The following suggestions are for Master’s or doctoral level students writing empirical dissertations—quantitative or qualitative—in the psychological therapies: including counselling, psychotherapy, and counselling psychology.  It was developed in collaboration with doctoral students on the University of Roehampton Doctorate in Counselling Psychology

The pointers below are only recommendations, and from one particular perspective (midway-ish between a realist and social constructionist standpoint). Different trainers, supervisors, examiners, and methodologies may view these issues in very different ways.

Qualitative analysis

  • Qualitative data can be enormously rich, but it’s large, complex, messy, and easily overwhelming. Like a dense forest. So the reader can easily get lost. That means that a good qualitative write-up really needs to guide the reader through the results. Make it easier for them to find their way—not harder. Remember that you will have spent weeks, maybe months, getting to know your data, so what might seem obvious and clear to you may be entirely unfamiliar to your reader.  Hold their hand as you walk along with them.

  • That means it is can be a good idea to give a table of the overall structure of your analysis and themes/subthemes at the start of your results section. However, if you give a table, you should ensure that the wording of the themes/subthemes on the table match, exactly, the headings/subheadings in your narrative account of the results.

  • Frequency counts in the table and/or in the text (usually the number of participants who were coded within a particular theme/subtheme), can help give the reader a sense of how representative different themes/subthemes are.  However, some approaches/qualitative researchers dislike this as they feel it is inconsistent with a qualitative epistemology and/or that it suggests more precision and generalisability than there actually is.  One option, in the narrative, is to use a system that labels different frequencies within broad bands. For instance:

    •  ‘All’ = All participants

    • ‘Nearly All’ = 100%-1 participant

    • ‘Most’ = 50%+1 to 100%-1

    • ‘Around Half’ = 50%+1 participants

    • ‘Some’ = 3 to 50%+1 participants

    • ‘A couple’ = 2 participants

    • ‘One’ = Only 1 participant

  • In your narrative account, it’s generally a good idea to use subheadings (and, if necessary, sub-subheadings) to break the analysis up, and to make it clear to the reader where they are in the account. Nearly always, these would be a direct match to your themes/subthemes/sub-subthemes. Alternatively, for your sub-subthemes, you can italicise the title in the text (making sure it matches what is in the table) to help orientate the reader.

  • Make sure that you integrate/summarise, in your own words, what participants are saying as much as possible, and don’t just give a series of quotes. It’s fine to give quotes to illustrate certain points or to give examples of what you’re describing, but this should not be a substitute for giving a thorough and comprehensive review of the data yourself.  Very long quotes may be better broken down, so you can be clearer with the reader about what you are trying to say/show.

  • The format of text in your results can be the same as throughout the rest of your thesis. So, for instance, only indent quotes that are 40 words or more long, don’t italicise quotes, put full stop before the reference for the quote if indented (and after if in the body of the text).

  • For referencing quotes, you should normally give the pseudonym of the person saying it, and a reference to where it is in their transcript (e.g., line number). So, for instance, ‘… (Mary, line 230)’. 

  • Normally, references to other literature should not be in the results section. Save that for the discussion.

  • Finally, above and beyond all the pointers above, it’s important that the way you write your results is consistent with your method and epistemology.  So, for instance, if you have adopted a social constructionist epistemology, don’t start making realist claims like, ‘Men were more defensive than females…’   Generally, the more realist your approach, the more you may want to use tables, frequency counts, etc.; while more constructionist epistemologies may lead to less structured and quantified analyses.

  

Quantitative analysis

  • Rather than just presenting stats and leaving it to the reader to interpret it, make sure you explicitly state what your findings mean (e.g., ‘Chi-squared tests indicate that men were significantly more likely than women to…’). In particular, be clear about which group was higher/lower than which.

  • In describing your findings, use precise language. Is it ‘significant’/’non-significant’?, refer to the specific effect size and stats: not ‘This seems to indicate that men were a bit more empathic than women’ but ‘Men were significantly more empathic than women (F = …).

  • Remember that, if you are using inferential tests, something is either significant or not. You can generally just about get away with talking about a ‘trend’ if the p value is between .1 and .05, but be very cautious; and make sure you don’t spend a lot of time interpreting or discussing non-significant findings.

  • Don’t just rely on significance tests. Give confidence intervals wherever possible and also effect sizes.

  • Be consistent in how many decimal points you use, and use only as many as is meaningful.  Does it really help the reader to know results down to four decimal points? Often just one is enough for means and standard deviations, maybe two or three for p-values.

  • Remember that, with the vast majority of statistical tests, you cannot prove the null hypothesis, so be sure to avoid phrases like: ‘This indicates that men and women had equivalent levels of empathy,’ rather ‘the difference in levels of empathy between men and women was non-significant.’

  • Although graphs can look pretty (especially with lots of colours!), tables are often a more precise means of presenting data, and generally mean that you can present much more data at once.

  • It’s rarely a good idea to just cut-and-paste SPSS tables – better to re-enter the data as a Word table so that you can get the formatting of the table appropriate to the journal.

  • The APA 6th Publication Manual has some great guidance on how to format and present all aspects of quantitative statistics.  An essential guide.

The Methods Section: Some Pointers

The following suggestions are for Master’s or doctoral level students writing empirical dissertations—quantitative or qualitative—in the psychological therapies: including counselling, psychotherapy, and counselling psychology.  It was developed in collaboration with doctoral students on the University of Roehampton Doctorate in Counselling Psychology

The pointers below are only recommendations, and from one particular perspective (midway-ish between a realist and social constructionist standpoint). Different trainers, supervisors, examiners, and methodologies may view these issues in very different ways.

The suggested word lengths are in the context of a 25,000-30,000 word thesis, but for a longer thesis the word lengths may not be that different.

Epistemology (approx. 2,000-3,000 words)

This may be a separate chapter on its own, or placed somewhere else in the thesis.

  • Critical discussion of epistemology adopted (e.g., realist, social constructionist)

  • Links to actual method used

  • Consideration/rejection of alternative epistemologies 

Design (approx. 50-500 words)

  • Formal/technical statement of the design: e.g., ‘this is a thematic analysis study drawing on semi-structured interviews, based in a critical realist epistemology’

  • Any critical/controversial/unusual design issues that need discussing/justifying

 Participants (approx. 500 words)

  • Site of recruitment: Where they came from/context

  • Eligibility criteria: inclusion and exclusion

  • Demographics (a table here is generally a good idea: can by one participant per row if small n, or one variable per row if large n)

    • Gender

    • Age (range/mean)

    • Ethnicity

    • Disability

    • Socioeconomic status/level of education

    • Professional background/experience: training, years of practice, type of employment, orientation

  • Participant flow chart/description of numbers through recruitment: e.g., numbers contacted, number screened, numbers consented/didn’t consent (and reasons). Also organisations contacted, recruited, etc.  

Measures/Tools (approx. 500 words)

  • Interview schedule

    • Nature of interviews: e.g., structured/semi-structured? How many questions?

    • Give key questions

    • Prompts?

    • (Full schedule can go in appendix)

  • Measures (including any demographics questionnaire)

    • Brief description

    • Background

    • What it is intended to measure

    • Example item(s)

    • Psychometrics:

      • reliability (esp. internal reliability, test/retest)

      • validity (esp. convergent validity)

 Procedure (approx. 500-1000 words)

  • What was the participants’ journey through the study: e.g., recruitment, screening, information about the study, consent, interview (how long?), debrief, follow up

  • Nature of any intervention: type of intervention (including manualisation, adherence, etc), practitioners…  

Ethics (approx. 500 words)

  • Statement/description of formal ethical approval

  • Key ethical issues that arose and how they were dealt with 

Analysis (approx. 1,000-2,000 words)

  • What method used

  • Critical description of method (with contemporary references)

  • Rationale for adopting method

  • Consideration/rejection of alternative methods

  • Stages of method as actually conducted (including auditing/review stages) 

Reflexive statement (approx. 250 words)

  • What’s your position in relation to this study?

  • What might your biases/assumptions be? 

 

 

The Literature Review: Some Pointers

The following suggestions are for Master’s or doctoral level students writing empirical dissertations—quantitative or qualitative—in the psychological therapies: including counselling, psychotherapy, and counselling psychology.  It was developed in collaboration with doctoral students on the University of Roehampton Doctorate in Counselling Psychology

The pointers below are only recommendations, and from one particular perspective (midway-ish between a realist and social constructionist standpoint). Different trainers, supervisors, examiners, and methodologies may view these issues in very different ways.

Aims

The aim of a literature review is to bring together what is known, so far, in relation to the question(s) being asked. So, for a decent literature review, the first thing is to be really clear about the question(s) that you’re asking.

Scope

At Master’s and Doctoral level, a literature review should demonstrate a comprehensive understanding of a particular field.  This generally means ensuring that your research question(s) is focused/narrow enough to allow for a comprehensive understanding.  If there’s too much literature on your question to know it all, your question is probably too broad—try narrowing it down.  

Ask yourself, ‘What do I feel confident in saying I am/will be a leading expert on?’  If that feels way above what you can achieve, narrow your focus down until it’s really possible for you to believe in your own expertise. 

You need to be at the ‘leading edge’ of a field.  Not what was talked about 20 years ago, but what is being discussed and debated now.  If you find most of your references are back in the 1980s and 1990s, think about why there’s nothing more current.  Is it that people have stopped being interested in this question?  Is it that you’ve missed the latest research?

At Master’s level, you need to demonstrate mastery of a field.  That is, not just that you know the literature, but that you can do things with it: e.g., evaluate the reliability of different sources of evidence, compare and contrast ideas.

At doctoral level, you should be able to demonstrate, not only mastery, but an ability to do things with the literature in independent and original ways: e.g., come up with new interpretations and perspectives.

So at both Master’s and doctoral level, you need to be able to go beyond simply describing relevant literature or findings, towards producing a synthesised understanding of the current state of knowledge in relation to your research questions.

Be critical.  This doesn’t mean insulting or attacking specific pieces of work—e.g., ‘Smith (2007) is an idiot for saying…’—and it doesn’t mean pulling things apart for the sake of it. What it means is being able to extract from the literature what is relevant to your own research questions, and to evaluate its importance to you.  That might mean, for instance, saying that the numbers in the study were small, so the findings may be unreliable; or that the use of quantitative methods means that we don’t really understand the mechanisms of change.

Should I do a ‘systematic’ literature review?

A systematic literature review involves pre-specified series of stages: e.g., specifying your search terms, reporting on your ‘hits’ and means of narrowing down your sources, and systematically analysing your findings.  These can be defined in a ‘protocol’.  An explicitly systematic approach may not be considered necessary for a Master’s or doctoral level thesis, but it is a means of demonstrating rigour and comprehensiveness.  At minimum, it is generally useful to show how you went about ensuring that you identify all relevant literature in your area (e.g., by including search terms, and information about the databases searched, in your appendix).

How do I make my case?

If you’re thinking, ‘How do I construct an argument so that I can show that I’ve got some good ideas here?’ you may be asking the wrong question for a literature review.  That’s fine for an introductory section of a thesis—showing why your question is of importance and relevance—but the aim of a literature review is to provide a balanced review of what we know so far, not to convince the reader of something.  So if the structure of your literature review goes something like, ‘Well x is really important, and so is y, and that means z is likely [and so I’m going to do some research now to show it is]’ you may need to backtrack.  Ask yourself, ‘What question am I asking?’ or ‘What is it that I don’t know that I am trying to find out?’  Trying to prove a point is never a great basis for a piece of research.

Format

Use headings and subheadings in each of the sections to keep a clear structure to the paper, but make sure that the hierarchy of these headings is clear to the reader: i.e., make the higher level headings bigger, bolder, etc. as compared with lower order headings (see APA manual).

Together, your sections should form a coherent argument. Try summarising each section into a single sentence and see if, together, they form a coherent paragraph.  If not, this might suggest that you need to revise the underlying structure.

Try to avoid ‘laundry list’ reviews: ‘stringing together sets of notes on relevant papers’ (McLeod, 1994, p.20) one after another.  For instance:

  • Smith (1992) found that…..

  • And Brown (2011) found that…

  • And Jones (1996) found that…

  • And then Green et al. (2001) found that…

Or narrative/historical version of a laundry list review: For instance:

  • First, Smith (1992) found that…..

  • Then Jones (1996) found that…

  • Then Green et al. (2001) found that…

  • Then Brown (2011) found that…

Remember that, at Master’s and doctoral level, a literature review is not just about précising previous research in the field: providing summaries of what lots of different studies said.  It’s about drawing the research together in coherent and meaningful ways.

So wherever possible, adopt a thematic style of review.  ‘This strategy involves the identification of distinct issues or questions that run through the area of research under consideration. Thematic literature reviews enable the writer to create meaningful groupings of papers in different aspects of a topic.  This is therefore a highly flexible style of review, in which the complex nature of work in an area of area can be respected while at the same time bringing some degree of order and organisation to the material’ (McLeod, 1994, p.20).  In a thematic review, it is likely that several different sources will be cited in one paragraph.

  • Some research has shown A… (Jones, 1996; Smith, 1992)

  • But other research has shown B (Green et al., 2001; Jones, 1996), although there are some problems with these findings (Grey et al., 1990).

  • More broadly, we know that Z… (White and Brown, 2001; Yellow, 2010).

  • And there is also some research to suggest X (Blue, 2003; Grey, 1994).

  • What we know so far, then, is that A seems very likely, and that is supported by Z and X, though B raises some problems about this.

 

When you review the literature, you don’t need to ascribe every study equal weight and space.  Indeed, if you are, it probably suggests you’re being too descriptive and not discriminating enough.  Some of the studies you look at will be spot-on relevant to your own research, some only tangentially so.  So if you’re extracting what’s really most meaningful to your own questions, you should be taking a lot more from some sources than others.  You’re not reviewing to make all these authors field like they’re being paid due regard.  You’re reviewing to take what you need from their work to say what we currently know in relation to your question(s).  If content isn’t relevant, leave it out.  If it’s highly relevant, say a lot about it.

A thematic approach really allows you to show a high-level, synthesised understanding.

Whenever you make claims about how things are (for instance, ‘empathy is a key factor in therapeutic outcomes’), you must always provide some reference for this.

Make sure you explicitly state somewhere, either at the end of the literature review or in your design, what the main aims/objectives of your study are, and, if relevant, your hypothesis/hypotheses.

Wherever possible, go back to the original sources and reference those, rather than ‘cited in….’  Never looks great—that you haven’t bothered to consult the original sources.  If you really can’t access the original source (e.g., it’s in another language, or out of publication and unavailable), that’s fine, but use citations sparingly.  And be really careful not to take references from a secondary source and cite them as if you have read them: find out what the original authors really said.

Don’t forget to use consistsent formatting/referencing, even for drafts (so your tutors aren’t spending their time correcting typos)

The Publication Manual of the APA can be an essential accompanying text for this piece of work. In particular: 

  •  Give page numbers for any verbatim quotes (preceded by ‘p.’, not colons)

  • Don’t give initials for authors (except where two or more have similar surnames and dates)

  • Only indent quotes if they are 40 words or more

  • No need to italicise quotes

  • Full stop after the (author, date) if the reference is in the text.  If it’s indented, it should come after

  • Use a basic font like Times New Roman (12 point) or Arial (11 point). No need for anything fancy

  • Check use of apostrophes

  • Use double spaced lines

  • Don’t italicise quotes, but do indent long quotes

  • Make sure separations between paragraphs are clear, either by tabbing the beginning of paragraphs (as per APA) or by having spacing between paragraphs

  • Use spell and grammar checks: those red lines on your Word files do mean something!

Most importantly, be consistent.  Most examiners won’t hold you to APA or any specific format, but once you decide to do something one way keep doing it that way throughout the thesis.

The 'target' approach to structuring your literature review

One way to think about structuring your literature review is like a ‘target’.  Start with the evidence that is most relevant to your research question (and perhaps do a systematic review of it).  Then what else might be most closely relevant?  For instance, if you’re doing a study on negative experiences of young people in person-centred therapy, you’d want to start by looking comprehensively for everything on that specific question.  But if there’s not much, then you could review the research on negative experiences of young people in other therapies, then negative experiences of adults in person-centred therapy.  The more literature there is at the ‘bullseye’ of your target, the less you need to go broader.  But if there’s really not much (and that’s fine), then broaden out to literature from which we might be able to extrapolate potential answers to your question(s).

The ‘pyramid’ approach to structuring your literature review

Another common approach is the pyramid one, where you start with the broadest area of literature on your topic, and then narrow downwards to more specific knowledge leading on to your research question.

Summary

Ultimately, a literature review is not about showing that you are smart and know things, or that you can follow a pre-specified methodology.  It’s about drawing on all your knowledge and skills to present your best understanding of the answers to your question(s), to date. 

You are to become the master in this field. And your reader is looking to you to give them an informed, rigorous, and up to date understanding.  Sometimes, the hardest bit of doing a literature review is feeling the confidence to be able to do that. You’re the teacher now, not the learner.