Quantitative Unease

A column dedicated to demystifying psychotherapy research – love it, hate it, or both…at least try to know what it’s all about!

Research Spirit

For better or for worse, the research spirit has invaded our dynamic matrices. Full of vitality, it haunts research opponents. “We’re clinicians”, they utter. But their voices are unintelligible in the current climate, which is a mixture of Christmas glory, scientific development and dogma.

‘In the name of the Father, the Son and the Holy Spirit.’ A research law has been laid down: “You must believe in experiments and statistics”, it says. Some psychotherapists protest. They try to negotiate, in vain. Filled with despair, the research spirit suddenly appears in front of them.

“Have I not convinced commissioners to fund group analytic studies?”, it asks in an authoritative tone. Left in awe, the intimidated clinicians glance at the spirit, who continues to speak. “Have your contracts not been extended as a result of these randomized controlled trials? Has a group analytic treatment manual not made life easier?” “Yes”, the therapists admit. Eager to please, the youngest of them identifies with the research spirits’ position of authority. “I’ve read an abstract in the Journal of Group Analysis”, he proudly announces. “And?”, someone asks, “what is it about?” “Group analytic therapy improved symptoms in borderline patients.” Merged with the spirit, he bathes in the research group’s success. Not for long.

“Group analysis isn’t a miraculous cure that can heal like traditional medicine”, one of the female analysts wryly remarks, “no matter how many trials they’ll conduct.” Still in identification with an assumed superiority, the young clinician pauses for a moment. “You can’t predict the future”, he replies, “and group analysis does make people better. Did you know that group analytic therapy was effective for borderline patients and the outcome was even better for long-term group analytic therapy? Its therapeutic benefit can’t be denied. Patients hurt themselves less and their relationships significantly improved clinically. Statistical analysis revealed this. Isn’t that a scientific miracle?”

Unwilling to replace her magical world of interpretive enquiry with experiments and numbers, the experienced analyst remains doubtful. “How did the patients feel?”, she queries. “Did they research their emotions?” “No.” Shaking his head, his heart is suddenly full of doubt. “They only studied symptoms and attributions”, he admits reluctantly, “although …”

Before he can give further details of the research project, another psychotherapist interrupts him. “I have come across a qualitative study, which explored emotions”, the therapist says, turning towards his female colleague. “I knew it, quantitative trials can’t examine subjective feelings. We must use phenomenological methods, otherwise we’re unable to study the experiential world of our patients”, she cries.

Demoralized but not totally defeated, the young clinician has a divine epiphany. “Does it have to be ‘either … or’?”, he asks the research spirit, who is listening. “The answer is right in front of you”, it responds and slowly rises. “You must believe in the magic of the quantitative paradigm”.

Ready to leave, the clinicians shout “wait, what do you mean?” United and with rediscovered confidence, they challenge the fading spirit: “There’s no magic in numbers!” With a twinkle in his eyes, the research spirit looks at them. “How do you know?” A simple, poignant question to which they have no answer. Gazing at the vanishing spirit, the quantitative non-believers see their confidence disappearing together with the spirit. Gradually, they lack the certainty that can be expressed with numbers.

“Can feelings be accounted for by one cause only? Or is pluralism acceptable? Can we believe in both experimentation and interviews?”, they ask and glance at each other. “It would depend on which philosophical position we adopt. If we embraced realism, that would make it easier,” a group psychotherapist suggests. “What about constructionism?” “Hmmm.” “Perhaps we could devise a methodology that incorporates both quantitative and qualitative methods?”, the female analyst mutters. No longer filled with qualitative wonder, confusion is in the air. Scratching their heads, the clinicians are left with even more questions than answers.

“Are mixed-designs a compromise or temptation to trespass?” Gazing at the picturesque ceiling, the spirit is no longer visible but they can still hear its words: “You must believe in the law of the Father.” “But research spirit, does the quantitative doctrine really demand that we give up its qualitative son? We’re creative group analysts and can draw on many philosophies and concepts.”

On the wall, they can see their Jungian Shadows, which are guiding their egos as they are examining various conceptualizations. “Is ‘oneness’ acceptable, it could illuminate the conflictual relationship? Or do we sacrifice our quantitative research group expertise by aligning with qualitative methods that investigate emotions?”, their questions echo through the hall.

Not knowing the answers, the clinicians wisely wait. They don’t want to fall in the same trap as their colleagues and quarrel with the spirit over methodologies. History has shown that this isn’t conducive to finding solutions. Initially, group analysis was an explorative method for which evidence was lacking. Since then, clinicians and researchers have worked together to show its effectiveness. Even though they succeeded, interpersonal conflicts between different research groups resulted in clinicians prematurely withdrawing from research studies. No norm was created from which group analysts individually deviate. Hence, some group analysts stick to the group analytic method and defend it with ferocity. Other analysts have embraced quantitative methods. Polarized points of view remain and the resulting friction is embedded in the matrices of process and outcome research. “This is unsatisfactory”, the sensible group of clinicians concludes. Ever present, conflicts need to be resolved so that group analysis can prosper. But how?

“The spirit tells us that evidence-based psychotherapy carries weight”, the young therapist says, “and it’s derived from quantitative research.” “So? That doesn’t help us with our conundrum.” His eyes meet other eyes. In the hall of mirrors, which constitutes the glorious world of group analytic research, it all becomes crystal clear. “Since there’s strength in numbers, two approaches, a combination of quantitative and qualitative methods, achieve more than one!”, he joyfully exclaims. “The research spirit is right, there is magic in numbers. It becomes apparent when we transcend the individual and are in groups.”

Wishing you a Merry Christmas and Happy New Year.

Dr. Susanne Vosmer
s.vosmer@gmail.com