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Lloyd, Christopher E. M. (2020) Psychological therapists’ experiences of goal-based practice within adult pluralistic private practice: an interpretative phenomenological analysis. Doctoral thesis, London Metropolitan University.
Background:
Outcome monitoring (OM) has been shown to support client progress in psychotherapy (Lutz et al., 2015). For the most part, this has taken place through the nomothetic tradition, which involves the client responding to a global and standardised checklist of psychological functioning (Alves, 2016). The idiographic tradition, however, represents an alternative whereby clients construct and rate progress against their own items, within a standardised questionnaire format (Sales & Alves, 2016). Idiographic measures take one of two forms: problem‐focused and goal‐focused. Problem‐focused measures ask clients to identify the difficulties, issues, or concerns that they want to overcome, and then to rate the extent of these problems. By contrast, goal-focused measures, or goal-based practices (GBP), invite clients to pinpoint the objectives that they would like to strive toward, and then the degree to which they have achieved them (Lloyd et al., 2019). For the latter, emerging evidence supports the validity, reliability and clinical utility of GBP (e.g., Di Malta et al.,
2019; Lindhiem et al., 2016; Lloyd et al., 2019; Smith, 1994; Tyron & Winograd, 2011).
Rationale:
Despite the significance that GBP may have for psychotherapy, there is a paucity of qualitative studies exploring how psychological therapists experience working with GBP with their clients. Given that pluralistic therapy (Cooper & McLeod, 2011) represents a specific form of therapy that fosters acceptance of therapeutic diversity, as well as a focus on explicit goal discussion and agreement, it seemed prudent to explore how therapists make sense of GBP within this framework.
Methodology and Results:
Interpretative phenomenological analysis (IPA) was selected for this research. Eight semi-structured interviews were conducted with psychological therapists working with GBP within pluralistic private practice. Three superordinate themes emerged from analysing the transcripts: a) a pathway through the jungle; b) invalidating the therapeutic journey; c) maintaining the clientled story. Results suggested that GBP could aid the therapeutic partnership through the monitoring of progress, by providing focus and increasing positive affect. However, GBP had the potential to detract from the client’s frame of reference, to jeopardise the therapeutic containment of sessions and to increase the client’s feeling of failure. The theme of ‘maintaining the client-led story’ emerged from the results as an antidote to what was experienced as non-humanistic GBP. Relational GBP entailed practitioners preserving time for therapy, reflecting on their own goals and agendas for their clients and maintaining principal focus on the therapeutic relationship; establishing this first and foremost, as a means to support their clients to create meaningful goals, which led to change.
Conclusion & Implications:
GBP can enhance psychotherapeutic work but cannot be separated from the primacy of the therapeutic relationship. Approaches to GBP, which dichotomise positive and negative aspects are likely to overlook therapeutic processes, which are vital to ensure GBP is collaborative and meaningful for the client. Results are discussed with reference to wider literature and the identity, ethos and praxis of Counselling Psychology (CoP).
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