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!

The Matrix of (Research on) Demand

Examining whether group analysis should adopt elements from mentalization-based group psychotherapy when treating borderline personality disorders, Kalleklev and Karterud (2018) found that “[i]nterventions with demand characteristics seemed to play an important role in the development of the mentalization group discourse” (p. 53).

Ahaaaa. My eyes remain fixed on the term “demand characteristics.” It refers to participants’ interpretations of how they think their researcher wants them to behave. That’s what behavioural research has taught us. Subjects try to make the experimenter like them by doing what they believe the experimenter wants.

If this sounds familiar, even if you don’t know anything about behavioural or experimental research, you probably have read Foulkes. He suggested that groups would tell their conductors what they thought the conductors expected from them and wanted to hear. Why should it be different for researchers and their participants? After all, we’re dealing with groups. Hence, the idea that participants want to ‘please’ their researchers comes as no surprise, because it’s a group phenomenon. Unfortunately, this bias messes up the results. Now that is a problem!

I re-direct my attention to Kalleklev and Karterud’s comparative clinical case study. “Demand questions”  – asking explicitly what patients feel and think about themselves and their attachment figures and “demand interventions”  – interventions, requiring a mentalizing response – stimulate mentalization processes in borderline patients, it says. Maximising mentalization in borderline patients is considered to be a good thing, because it fosters their ability to perceive, think and act appropriately in the face of life problems. Kernberg proposed that. So if “demand interventions” facilitate mentalization, this has to be positive, or not?

While I ponder this and scan through the limitations of the case study, I can feel internal dissonance arising. Perhaps it’s not just the coffee but the word “demand” that makes me ache? Derived from the Latin word “demandare” (hand over), the meaning of this term is unambiguous. There’s no doubt about the outcome, because when someone “demands”, s/he asks for something forcefully and doesn’t expect to be refused.

I conjure up an image of a group analyst, who gets his borderline patients to mentalize by asking them “demand questions”. The patients conform, because patients have an astonishing ability to do so, Foulkes suggested. Well … apart from those, who want to skew the results and attempt to do the opposite of what they think is expected from them.

The group analyst can no longer use deception, which is one way of ensuring that participants can’t determine how the researcher wants them to behave, because the matrix of demand is already in full swing. And the promising research outcome (mentalization) is evident from the processes within the expanding network of ‘mentalization on demand’. The group therapist can prove it, the prefrontal cortices in group members’ brains are lighting up while they’re mentalizing and thinking about themselves in a civilised fashion, without drama and threats.

I pause, let go of this image and engage my own brain cells. Since when have compliance, conformity and submission been considered desirable and linked to the (scientific) group discourse? What about freedom of choice, learning to change and act otherwise? I pause for another moment whilst pondering this.

Ironically, “demand questions” and “demand interventions” seem to foster functional behaviours in borderline patients. But then again, one case study of single sessions doesn’t provide us with sufficient evidence. However, it’s nevertheless intriguing what “demand questions” could achieve, isn’t it? Or shall I call it concerning? When “demand” becomes the vehicle for change, it smells of authoritarian processes, which are probably based on fear (of abandonment in patients and failure in therapists). So ‘scientific power’ promotes dependency. Surely this isn’t what Kalleklev and Karterud had in mind?

Whilst I try to disentangle my (counter)transference reactions from the matrix of demand, I’m reminded that being involved in research can impinge on both patients’ and group conductors’ (un)conscious experience of groups. Hmmm. That might give us a clue what else is going on. I conclude that perhaps a mentalizing approach is required when we’re dealing with “demand characteristics”. Participation in studies that investigate mentalization-based groups to find out, which elements, if any, we can adopt in group analysis that enable patients to become the persons they want to be, seems a way forward.

Or we could design some neat experiments that could provide us with more definitive answers. If experimentation and experimental studies sound too radical, remember that they can produce systemic bodies of knowledge, be used effectively to test group analytic theory and offer insight into underlying processes. And deception forms part of the package in order to avoid “demand characteristics”, you don’t need to have ethical concerns about this. All is transparent and in the open, at least within the research community. That’s what the matrix of (research on) demand is all about, isn’t it?

Wishing you a very successful, experimental autumn.

Reference

Kalleklev, J. & Karterud, S. (2018) A comparative study of mentalization-based versus a psychodynamic group therapy session. Group Analysis. 51(1): 44-60.

Dr Susanne Vosmer
s.vosmer@gmail.com