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Exploring Learning Outcomes in CBT and Existential Therapy in Denmark

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Exploring Learning Outcomes in CBT and Existential Therapy in Denmark Exploring Learning Outcomes in CBT and Existential Therapy in Denmark Submitted to Middlesex University and the New School of Psychotherapy and Counselling in partial fulfilment of the degree Doctorate (DProf) in Psychotherapy and Counselling. By Anders Dræby Sørensen Academic supervisors: Rosemary Lodge & Emmy van Deurzen Middlesex University Student Number: M00252793 March 2015 Content Acknowledgements 6 Statement of copyright and originality 7 Word Count 7 Abstract 8 List of figures 10 Chapter 1. Introduction 11 1.1. Aim of research 11 1.2. Relevance of research to the field of psychotherapy 12 1.3. Personal motivation for research 13 1.4. Schedule of changes 14 Chapter 2. Review of literature 15 2.1. Dominant trends in the evaluation of psychotherapy 16 2.1.1. The relevance of evaluating the conceptual and empirical foundations of psychotherapy 16 2.1.2. Clinical guidelines and evidence-based assessments 17 2.1.3. The medical model 17 2.1.4. The outcome of psychotherapy 18 2.1.5. Challenges 19 2.2. Evaluation of psychotherapy in terms of learning 20 2.2.1. Learning outcomes and educational objectives 20 2.2.2. The tradition of integrating psychotherapy and learning theory 22 2.2.3. The relevance of evaluating psychotherapy from a learning perspective 21 2.2.4. The relevance of evaluating experienced learning outcome in Existential therapy (ET) and CBT 26 2.3. The integration of learning models in Cognitive Behaviour Therapy (CBT) 27 2.3.1. Behaviourism and behaviour therapy (BT) 27 2.3.2. Cognitive psychology and cognitive therapy (CT) 28 2.3.3. Cognitive-Behaviour Therapy (CBT) 31 2.3.4. Facilitation of learning in CBT 34 2.3.5. Educational objective of CBT 36 2.4. Existential theory of learning and Existential therapy (ET) 37 2.4.1. Existential theory of learning 37 2.4.2. Existential therapy (ET) 39 2.4.3. Existential therapy as process of learning 41 2.4.4. Facilitation of learning in ET 42 2 2.4.5. Educational objective of ET 43 2.5. Theoretical comparison of CBT and ET 44 2.5.1. Conception of human being 44 2.5.2. Learning in psychotherapy 44 2.5.3. Therapeutic relationship and facilitation of learning 46 2.5.4. Life problems and the medical model 47 2.5.5. The active and reflected client 48 2.6. Research questions 49 2.7. Joining research objectives and research questions 49 Chapter 3. Methods and procedures 51 3.1. Choice of methodology 51 3.2. Qualitative research 53 3.3. Phenomenology and hermeneutics 55 3.3.1. Transcendental and descriptive phenomenology 56 3.3.2. Hermeneutic phenomenology 57 3.3.3. Hermeneutics 57 3.4. IPA 60 3.5. Quality in IPA 62 3.6. Sample and recruitment 63 3.7. Data collection 65 3.8. Data analysis 75 Chapter 4. Ethics 92 4.1. Consent 93 4.2. Confidentiality 93 4.3. Discomfort and harm 93 4.4. Precautions by proofreading 94 Chapter 5. Presentation of results 95 5.1. Existential therapy (ET) 98 5.1.1. ET master theme 1 (E1): Motivation 98 5.1.2. ET master theme 2 (E2): Self and life 104 5.1.3. ET master theme 3 (E3): Thinking, acting and feeling 114 5.1.4. ET master theme 4 (E4): Relationships with others 119 5.1.5. ET master theme 5 (E5): Therapy and therapist 122 5.1.6. ET master theme 6 (E6): Evaluation of outcome and process 129 5.1.7. Summary of findings from ET 131 5.2. Cognitive Behaviour Therapy (CBT) 137 5.2.1. CBT master theme 1 (C1): Motivation 138 5.2.2. CBT master theme 2 (C2): Self and life 141 5.2.3. CBT master theme 3 (C3): Thinking, acting and feeling 146 3 5.2.4. CBT master theme 4 (C4): Relationships with others 151 5.2.5. CBT master theme 5 (C5): Therapy and therapist 155 5.2.6. CBT master theme 6 (C6): Evaluation of outcome and process 159 5.2.7. Summary of findings from CBT 161 5.3. Comparison of master themes from ET and CBT 165 5.3.1. Master theme 1: Motivation for therapy 166 5.3.2. Master theme 2: Self and life 168 5.3.3. Master theme 3: Thinking, acting and feeling 169 5.3.4. Master theme 4: Relationships with others 170 5.3.5. Master theme 5: Perception of therapy and therapist 172 5.3.6. Master theme 6: Evaluation of learning process and outcome 174 5.3.7. Summary of comparison 175 Chapter 6. Discussion 177 6.1. Discussion: Existential therapy (ET) 177 6.1.1. Motivation for ET 177 6.1.2. Learning outcomes of ET 181 6.1.3. Therapy in ET 192 6.1.4. Therapist and therapeutic relationship in ET 194 6.2. Discussion of findings from CBT 198 6.2.1. Motivation for CBT 198 6.2.2. Learning outcomes in CBT 201 6.2.3. Therapy in CBT 210 6.2.4. Therapist and therapeutic relationship in CBT 214 6.3. Discussion of comparison 215 6.3.1. Motivation for psychotherapy 216 6.3.2. Learning outcomes in psychotherapy 219 6.3.3. Therapy in psychotherapy 227 6.3.4. Therapist and therapeutic relationship in psychotherapy 232 6.4. Reflexivity 235 6.4.1. Reflections into data collection and analysis 235 6.4.2. Influence from researcher 236 6.4.3. Limitations of the research 239 6.4.4. Strength of research 241 6.4.5. How does this research and its strengths inform the future of therapy? 242 Chapter 7. Conclusion 243 7.1. Implications for theory and practice 243 7.1.1. Motivational learning 245 7.1.2. Structure of learning outcomes 247 7.1.3. Learning about initial and previous experiences 249 7.1.4. Learning outcomes in three domains 251 4 7.1.5. Learning design 253 7.1.6. The educational role of therapist and therapeutic relationship 259 7.2. Suggestions for future research in the field of psychotherapy 260 References 262 Appendix 0A: Research schedule with research questions and objectives 273 Appendix 0B: Timetable 276 Appendix 1. Interview guide 277 Appendix 2. Transcript of interview 3 in English 279 Appendix 2B. Transcript of interview 3 in Danish 292 Appendix 3. Table of super-ordinate themes and emergent themes, Interview 3 299 Appendix 4. Table of super-ordinate themes and illustrative quotes, Interview 3 305 Appendix 5. Information sheet 308 Appendix 6. Consent form 311 Appendix 7. Ethics approval 313 Appendix 8. Existential therapy master theme 1(E1) with table of recurrent themes 314 Appendix 9. Existential therapy master theme 2(E2) with table of recurrent themes 315 Appendix 10. Existential therapy master theme 3(E3) with table of recurrent themes 317 Appendix 11. Existential therapy master theme 4 (E4) with table of recurrent themes 318 Appendix 12. Existential therapy master theme 5(E5) with table of recurrent themes 319 Appendix 13. Existential therapy master theme 6(E6) with table of recurrent themes 320 Appendix 14. CBT master theme 1(C1) with table of recurrent themes 321 Appendix 15. CBT master theme 2(C2) with table of recurrent themes 322 Appendix 16. CBT master theme 3(C3) with table of recurrent themes 323 Appendix 17. CBT master theme 4(C4) with table of recurrent themes 324 Appendix 18. CBT master theme 5(C5) with table of recurrent themes 325 Appendix 19. CBT master theme 6(C6) with table of recurrent themes 326 Appendix 20. Overall table of master themes 327 Appendix 21. Conclusion tables 329 Appendix 22. Overall conclusion table 332 Appendix 23. Summary diagrams 306 5 Acknowledgements Jonathan Turner performed professional proof reading. I owe a deep gratitude to my supervisors, Dr. Rosemary Lodge and Dr. Emmy van Deurzen, who helped me through this research project. I owe a sincere gratitude to my mother, Margit, without whom my research project would not have been possible. I dedicate this thesis to her. Finally, I would like to say thank you to my examiners, Dr. Simon du Plock and Dr. Pavlos Filippopoulis for their time and valuable comments. 6 Statement of Copyright and Originality This is an original research project. The Ethics Committee at the New School of Psychotherapy and Counselling provided ethical approval for this work. No parts of this thesis may be reproduced in any form without the written consent of the author, except the librarian at the New School of Psychotherapy and Counselling and the Middlesex University Research office who is allowed to reproduce this thesis by photocopy or lend copies for academic purposes. Anders Dræby Sørensen, 2015. Word count including spaces 58.968 words (79.745) 7 Abstract The purpose of this thesis is to draw attention to the special characteristics of the outcome of psychotherapy through qualitative research. The thesis explores a phenomenological and hermeneutic enquiry into the lived experience of psychotherapy in terms of learning outcomes. This includes both Existential therapy (ET) and Cognitive-behavioural therapy (CBT) and their possible differences and similarities. I can describe learning as any experiential change that occurs in the participants understanding as result of the therapy in which they participate. Learning outcomes are concerned with the achievements of the learner rather than the intentions of the educator, as expressed in the objectives of an educational effort. The thesis uses Interpretive Phenomenological Analysis (IPA) as a qualitative method to explore meanings of the learning phenomenon generated from themes found in transcripts of semi- structured interviews from twelve participants with an equal length of short time client experience of psychotherapy.
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