FROM MORAL DOGMATISM
TO CRITICAL THINKING ABOUT MORAL ISSUES
IN COUNSELLING AND THERAPY RESEARCH
A double-assignment
for 2004-5 and 2005-6
by Jim Byrne, MA(Ed), Dip.CP.Psych.(Rus).
Professional Doctorate in Counselling - University of Manchester
Faculty of Education (ESI)
1. Foreword
My journey from moral dogmatism, (or dogmatisms: including childhood Catholicism and young-adult Marxism), towards a developed capacity for moral reasoning about counselling ethics, began in September/October 2004. At that time I had the beginnings of an idea for a research project, and I knew I would have to be able to “say something” about the ethical implications of my proposed study before I could proceed. (McLeod, 1994). However, this journey has not been either smooth or linear. It has involved a great deal of soul-searching, and the development of several approaches to my challenge: each of which had to be abandoned for one reason or another. For examples, I abandoned my attempt to “tack” ethics on to the end of my proposal. I then aborted my attempt to commence my project proposal with the topic of ethics as the foundation. And I abandoned my attempt to construct a proposal based entirely on values and ethics. (De Bono, 2005 and 1995). Some of these terminations and restarts were driven by changes in my thinking, and some by practical considerations, such as grossly exceeding the word limit. In all I wrote at least the following documents:
• 29,000 words – Ethics assignment 1 - http://assignment1g.blogspot.com/
• 8,600 words – Outline proposal 7 - http://draftproposal7.blogspot.com/
• 10,600 words – Planning a qualitative research project: 2 - http://projectplanning2.blogspot.com/
• 2,800 words – Appendix A - http://interviewschedule.blogspot.com/
• 9,500 words - Appendix B2 - http://appendixb.blogspot.com/
• 1,700 words – Appendix G5: http://draftreferences.blogspot.com/
• 1,000 words - Appendix I: http://conceptfan.blogspot.com/; plus:
• Approx 19,770 words - The present document.
So, conservatively estimated, I have written at least 83,000 words, (and possibly more than 90,000 words), to arrive at my present position of believing I have some developed capacity to think rationally and critically about moral issues in counselling and therapy research.
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2. Introduction
This document began its life as Appendix B to my (now abandoned) draft project plan, which was entitled: Planning a Qualitative Research Project in Counselling and Psychotherapy: Using a Heuristic Approach. (See http://project-planning-2.blogspot.com/). I created that draft project plan on 11th April 2005, after abandoning my (earlier) original research proposal. A few days into my second draft project plan, I realized that I could not continue to work on that new plan without clarifying my “ethical foundations” to the point of some kind of conclusion.
Therefore, I switched to working on what was then Appendix B of that plan, (and which is now this document). However, within a couple of weeks it became clear that there was so much work to be done on thinking about ethical considerations that, at the very least, a 10,000 word paper on ethics would be required; (and that then grew to an almost 20,000 word document; and potentially a thirty- or forty-thousand word document!). I had to find some way to narrow my focus, in order to manage my word limit. Consequently, I set out to consider some of the following questions:
• What is my stance on ethics in general, and “applied” professional ethics in particular?
• How is my stance on ethics impacted by my earliest, and subsequent, moral training?
• How can I develop a reasonable level of confidence in my ability to design a research project that would be clearly ethical?
• How can I become “ethically mindful”, rather than (merely) a dogmatic respondent to emotive intuitions?
• And, can I become a “critical thinker” in the realm of ethical debate and risk assessment?
I originally wrote a draft research proposal, commencing in November 2004, filled with confidence that I had a good research idea for my second year of doctoral study. That proposal had the following draft title:
A Consideration of the Placebo Effect and the Possibility of Identifying Some ‘Active Ingredients’ in the Stories of Six Counselling and Psychotherapy Clients: A qualitative phenomenological study.
Using Interpretative Phenomenological Analysis (IPA), I was going to interview six individuals who had had a positive therapeutic outcome from counselling and therapy, to see if I could identify some “active ingredients” in their counselling/therapy that could be said to have brought about the positive outcomes reported by these participants: (Smith, 1995, 1996, 1999, 2004; Wampold, 2001a, 2001b; and: Wampold, Ahn and Coleman, 2001). The individual respondents would come from a variety of backgrounds, in terms of the type of counselling and therapy undertaken (e.g. psychodynamic, person-centred, cognitive behavioural, etc.,), and none of them would be former clients of mine. Therefore, these “active ingredients” would not be “therapy specific”, or “specific ingredients” as described in Wampold (2001b: 14); but rather “common factors” as defined by Wampold (2001b: 22). If I could show that my six respondents had indeed identified some kinds of “common elements”, or “active ingredients”, then the idea that they could have achieved a positive therapeutic outcome entirely or largely as a result of a placebo effect – as implied or asserted by Horgan (1999) and Erwin (1997) - could be seriously challenged, destabilized and brought into question. (See also Griffin and Tyrrell 2004: 223).
However, when I finished my draft proposal, I realized that it was “a bit thin” on the subject of research ethics, and, in particular, I had “bolted” the ethics section on to the end of the proposal, because I “had to” consider this topic. My feeling at that time was that I “really” did not need to do anything on the subject of ethics in order to make my research project safe. I considered that it was about as benign as could be, and that it was just the formal requirement to include something “credible” on ethics that was concerning me. I mentioned to Clare Lennie that I could see that my ethics section was thin, and that it was not an integral part of the proposal, and she agreed with me that further work on ethics seemed to be called for. I therefore set out to find some way of improving my ethical stance on research issues in general, and on the ethical foundations of my research proposal in particular: not because I wanted to, but because I felt I “had to” in order to avoid a mere “fudge” of the topic for the sake of appearances. Soon afterwards, once I had begun my rethink, I came to appreciate that this is actually a very important and rewarding area of study. What follows is the beginning of an enquiry designed to promote the development of some kind of new, personal, ethical foundation, based upon thinking rather than intuitions: (or, rather, thinking about intuitions and prima facie principles, rather than emotively acting upon intuitions alone: (Hare, 1981: 25-26 and 87-92; and Marinoff, 2004: 25-53).
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3. Overview of the Educative and Imperative Components of Bond’s (2004b) Research Guidelines
Although I did not begin this study with the BACP research guidelines (Bond 2004a, 2004b) in mind, I have come to realize that it is important to use existing ethical codes as part of the basis of my work in arriving at some kind of ability to conduct my own risk assessments in counselling and therapy research. (Bond, 2004b: 11). Therefore, I set out to try to understand Bond (2004b), by analyzing its structure. I have divided the relevant principles of the guidelines on research ethics - (Bond, 2004b) - into two groups: the imperative and the educative, using a quite liberal definition of the educative principles. I now want to sample the educative principles, and to analyze them for their structure and content, so I can make some decisions about what they imply for the concept of ethical mindfulness. Since there are 21 educative principles (in my classification), I propose to take principles 1, 11 and 21, as my sample, and to analyze them. I may include others later, if necessary.
1. “It is part of the practitioner’s responsibility to be sufficiently trustworthy to enable constructive working relationships with clients. Trust requires a quality of relationship between service user and provider that is sufficient to withstand any challenges arising from inequality, difference, uncertainty and risk in their work together”. (Page 10).
11. “There is an ethical expectation of researchers that they actively seek opportunities to communicate any learning from research that is relevant to participants, practitioners, policy makers, academics and others with valid interest in the research”. (Page 15).
21. “Research integrity is strengthened by deploying strategies and procedures for responding to complaints promptly and fairly”. (Page 17).
Before going on to reflect upon these three selected principles, I want to mention that Bond (2004b) has provided what might be called an “orienting device” to help researchers to know “where” to look, and “what” to look for in locating themselves in the ethical landscape: namely to look at their own trustworthiness:
“The distinctive ethical dimension of counselling and psychotherapy practice is the trust placed by clients in practitioners. This trust is not only essential to achieving the client’s aspirations but also for the practitioners to establish the quality of relationship and interaction that makes the work possible”. (Page 10).
This seems to me to be quite a clever device, in that it rolls virtue ethics and consequentialism into a neat partnership, which is quite likely to motivate readers of these guidelines to strive for trustworthiness. This seems to be true, firstly, because many if not most people desire to think of themselves as being virtuous. I do not agree with Plato that nobody would knowingly do wrong, and that wrongdoing is the result solely of ignorance. This is quite clearly not true. (The view expressed by Albert Ellis, 1994, that bad behaviour results from individuals being too ignorant, too stupid or too disturbed to do otherwise, seems to me to be more accurate). However, what may be true is that many if not most people – especially in the caring professions - would like to have a reputation for being trustworthy; and these guidelines tell the researcher how to get that reputation – by behaving in a way that is patently trustworthy. The second motivational element is the consequentialism, which amounts to the claim that: If you behave in a trustworthy manner, (which is the initiating action), you are much more likely to establish the kind of relationships which will get you to the point of successfully being able to complete your research (which is the desirable consequence). Many if not most researchers, anxious to complete their research successfully, are likely to be strongly affected by this promise of the self-efficacy of trustworthy behaviour.
Thus, this central organizing principle of the new guidelines is surprisingly elegant in providing a virtue-ethics and consequentialist (or utilitarian) motivational commitment for what follows: which is a mixture of prescription and recommendation, or deontology and exhortations. The prescriptions, or imperatives, are unremarkable; and my focus is upon the so-called educative principles, which, it is claimed, will promote mindfulness.
So now, here is the crunch question: In what way or ways do the three non-imperative principles, presented above, promote mindfulness, which is not also true of the following three imperative principles. (I have selected imperative principles 1, 10 and 20, because there is no imperative principle 21).
1. “Whenever unavoidable risks are identified, the researcher should consider, in consultation with appropriate others, whether it is ethically justifiable to carry the research forward and, if so, what safeguards are required”. (Page 11).
10. “Good practice requires: 1. A firm commitment to striving for fairness and honesty in the collection and analysis of all data and in how those findings are presented, as fundamental to the integrity of the research”. (Page 15).
20. “The competence of the researcher(s) to undertake the proposed research should be considered in the initial risk assessment”. (Page 16).
There is no obvious difference in terms of mindfulness promotion, in my view. Both the educative and the imperative principles refer to various problems that might arise with a research project, so in that sense they are both educative. The imperative ones not only educate us with regard to what they are, but also insist that they be implemented. The educative ones educate us with regard to what they are, and strongly influence us to implement them, in order to be “a virtuous researcher” and to be “efficacious”, as mentioned in my discussion of the “orienting device” above.
In this sense, mindfulness is just “awareness”, and not a capacity to think; and certainly not a system of thinking, or skills for thinking about ethics, or techniques, etc. Therefore, this is a code, a set of guidelines, and not an introduction to a system of mindfulness. And yet, I am strongly of the opinion that that is precisely what I require in order to be a good researcher – a system of critical thinking skill which will allow me to work out the implications of ethical dilemmas from first principles! There are no first principles in this set of guidelines (as far as I can tell, given my definition of ‘first principles’), only derived and fully formed, and set in concrete, principles, both imperative and strongly recommended. Or to put it another way, to the extent that these are first principles, they are also final and fixed principles and prescriptions.
The kind of mindfulness advocated by Bond (2004b) seems to me to be (largely) achievable by reading these guidelines repeatedly, and then relating them to our own ideas for research project designs. (This I will attempt to do in Sections 6 and 7 below). However, the kind of mindfulness I want to try to develop would involve being able to think for myself from diverse sources of ideas, attitudes, principles, systems, and so on. And that is what I shall attempt to develop in Sections 4 and 5 below). Badiou (2002: 3) certainly believes that modern ethics prevents thinking, [by “…a threatening denial of thought as such…”], by prescribing final attitudes as fixed points). On the other hand, Badiou is an anti-humanist and a subjectivist, while I am in favour of humanistic thinking, and social agreements about moral codes, rather than individual subjective responses.
At this point in my quest, I am no closer to understanding how to think about moral issues. But I am a bit clearer about what my goal is: to develop a system of critical thinking that will allow me to work out my own application of ethical principles to moral issues.
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4. Moral Thinking as ‘Critical Thinking’
In the early months of my research, I read dozens of papers and books on various aspects of my proposed study, including some background texts on ethics. (Blackburn, 2001; Keown, 2005; Gregory, 2003; Leaman, 2000; Willig, 2001; McLeod, 1994; Hope, 2004; Harrison-Barbet, 1990; Banyard and Flanagan, 2005; McLeod, 2001).
Somewhere in May or June 2005, I found Hare (1981) in the Oxfam bookshop in Bradford. I had spent weeks trying to figure out how to think about moral issues, and I was really floundering. Suddenly, here was a dusty old book right in front of me entitled: ‘Moral Thinking: It’s levels, method and point’. I was drawn to the possibility of learning a method of moral thinking, not because I (consciously) thought that there is an absolute moral reality, or any absolutely certain moral knowledge, but because I wanted to get beyond simple rule following: or following the rules of others. (At least that was how it seemed to me at that time. I now wonder if there might not have been an unconscious desire for certainty). I had identified eight actual or potential problems with my research proposal (which number has now risen to fourteen!), and I wanted to be able to think my way through those problems in a way that would help me to be reasonably sure that I was designing a safe and helpful proposal; and one I could defend from all potential detractors. Over the summer, I read this book by Hare, and reviewed my notes from it many times, and still I am not clear what the promised ‘method’ of moral thinking is. Therefore, in this section, I want to do some thinking on paper about Hare (1981), so I can reach some kind of conclusion to this quest.
According to Hare:
“We want the moral philosopher to help us to do our moral thinking more rationally. If we say this, we presuppose that there is a rational way or method of going about answering moral questions; and this means that there are some canons or rules of moral thinking, to follow which is to think rationally. The moral philosopher asks what these canons are”. (Hare 1981: 1)
Hare twice eschewed ontology, which he does not consider essential to moral philosophy. (Hare, 1981: 6). This is rather convenient for him, in that he has sidestepped the question of the ontological status of moral claims, such as: “This is a good act”. However, he can justify this step, since he does not consider that moral statements are statements of (descriptive) fact, but rather statements of prescriptive preferences, which have been universalized using a combination of utilitarianism and Kant’s deontology. (In other words: “…moral words have … a commendatory or condemnatory or in general prescriptive force which ordinary descriptive words lack…”: Hare, 1981: 71)
His reasoning goes something like this: Because I would prefer it if nobody harms my body, which I definitely do prefer, I am logically obliged to insist that this not happen. That is to say, it seems intuitively logical to me that other people MUST NOT harm my body. The same principle would apply to my property, possessions, and relatives, and so on. Moreover, since I feel this way, it seems to me that other humans would feel likewise, and I can collect evidence about this if I wish, and indeed can hardly avoid collecting such evidence. The next step is to fully identify with other individuals in my life who are subject to some threat, as if I might be in their position; and, by empathizing with them I will now want for them what they (implicitly) want for themselves: to escape from that threat. (This is the ethic of care – Chaffee, 1998: 330). Therefore, it would be wrong of me to inflict upon them anything that I would not wish them to inflict upon me. (And this is the ethic of justice – Chaffee, 1998: 228). From this we get to the stage of working out the ‘universal preferences’ of all individuals, as if we knew their minds, and to then prescribe that they MUST be treated in this way, and MUST NOT be treated in some other way. (Of course, this kind of reasoning often breaks down; as we do not all share the same preferences in practice. [However, there is probably a good deal of overlap in the preferences of most individuals in relation to certain major possibilities, such as assault, pain, pleasure, death, and so on. {Which is not to deny that there are very real cultural and sub-cultural, as well as some psychological, differences of taste}]).
However, the musts described in the previous paragraph are not the musts of modal logic: (Hare 1981: 23). They are the musts of logically derived prescriptions based originally on preferences and emotional commitments. In addition, just as prescriptions are not descriptions, moral rightness is not empirical correctness:
“Nowhere here can we find a way of checking the correctness of any moral opinions. To suppose that we can is to confuse moral philosophy with various kinds of empirical science such as anthropology and linguistics, as some moral philosophers appear to be doing…” (Hare 1981: 15).
In chapter 2, Hare deals with moral conflicts, or conflicts between two moral intuitions, such as I experience in relation to problems 6 and 7 in my problem list. That is to say, generically, if my solution to problem 7 is to proceed with action x, I then find I am in default of my preference expressed in problem 6, and vice versa. This is perhaps the strongest case that we can make for having a system of critical thinking about moral intuitions, which is what Hare’s method of moral thinking is essentially about. That is to say, if our innate tendencies and our earliest education results in us having moral intuitions that guide our actions for the rest of our lives (most of the time, and under most conditions), this may work perfectly well if we always and only have one intuition in any one situation. But what shall we do when we find ourselves in a situation where we experience conflicting intuitions, and thus conflicting action-tendencies? We clearly need to be able to evaluate the two intuitions, and choose between them on some basis. And the basis chosen by Hare (1981) is utilitarianism, supported, for very good reasons, by Kant’s universalization rule.
Hare (1981: 25) proposed a two-level system of moral thinking: the intuitive and the critical. He traces such a system back to Plato and Aristotle, and speaks approvingly of Plato’s distinction between “knowledge and right opinion”. This refers back to Plato’s analogy of the cave, and the shadows which normal humans take to be realities. Plato labelled the misperceptions of the cave dwellers as (mere) “right opinion”, based on imperfect senses. And he contrasted these distorted perceptions against the “true perceptions” of the rationalist philosopher, which he labelled as “knowledge”. I have to reject this view because, in Plato’s theory, true knowledge was derived entirely from introspective reasoning, and was not in any way “sullied” by experience, or what we would today call “empirical data”. This makes the two levels problematical for me.
However, if we detach Hare’s model from Platonic idealism, we can say that all humans seem to have intuitions, or ‘automatic thoughts’, and urges, when faced with what we call a ‘moral problem’. We have a sense of what would be the ‘right’ thing to do, and this seems to be strongly shaped, or even originally constructed, by our family group and society, with our participation. Moreover, we probably have some innate tendencies that get shaped in that socialization process. (In the case of counsellors and therapists, our intuitions also seem, often or mainly, to be influenced by professional codes of ethics. However, this is not always the case, otherwise we would not have the occasional scandals about counsellors and therapists exploiting or abusing a client that we regrettably do have).
So what then is Hare’s (1981) model of critical reflection upon moral intuitions? What are its main elements? And how is it to be applied? Can I apply it to my original eight (and now 14!) ethical dilemmas, or issues?
Irritatingly, his next discussion point is not the critical thinking model at all, but rather experimenting with the idea of dispensing with that model, and simply juggling the two moral intuitions that are in conflict. In my case, his advice would amount to this. Let us say that my current position is this: Proceed with act 6 (which disallows act 7); or proceed with act 7 (which disallows act 6); and these are clearly in conflict. Hare (1981) suggests that I could identify which of these actions would be the more harmful, and then to choose as follows: e.g. “Do not proceed with act x, unless not proceeding would allow the worse act (y) to occur”. This would be a strategy of minimizing harm, as opposed to doing no harm; and as such, it might not be acceptable to me. Thus, a one-level system of moral reasoning does not seem to be suitable for my purposes: (Hare 1981: 32-35). This amounts to a rejection of intuitionism.
Marinoff (2004: 29) has a further objection, as follows:
“Teleology (or consequentialism – JWB) has … weaknesses … It presupposes that we know how to measure ‘goodness’ or ‘badness’ of outcomes, as if they were so much meat or so many vegetables on a scale. In fact, no one has a clue how to measure good or bad. So if there can be no universal agreement as to whether a given outcome is good or bad, there can be no agreement as to whether the act that produced it is right or wrong. There can only be a self-justifying consensus, which could be abused to support even great evil”. (Marinoff, 2004: 29).
When there is a question about conflicting intuitions, it needs to be settled by appeal to factors other than our intuitions, otherwise we are stuck in our conditioning, pure and simple.
“What will settle the question is a type of thinking which makes no appeal to intuitions other than linguistic. I stress that in this other kind of thinking, no moral intuitions of substance can be appealed to. It proceeds in accordance with canons established by philosophical logic and thus based on linguistic intuitions only. …
“Critical thinking consists in making a choice under constraints imposed by the logical properties of the moral concepts and by the non-moral facts, and by nothing else. …” (Hare 1981: 40).
Hare (1981: 42) goes on to present a brief outline of his method of critical thinking, as follows:
“What critical thinking has to do is to find a moral judgement which the thinker is prepared to make about this conflict-situation and is also prepared to make about all the other similar situations. Since these will include situations in which (s/he) occupies, respectively, the positions of all the other parties in the actual situation, no judgement will be acceptable to (him/her) which does not do the best, all in all, for all the parties”.
He is here invoking Kant’s universalization principle, which is one of Kant’s three forms of the Golden Rule: Do not act on any principle that you would not at the same time have instituted as a universal rule, to which you would personally be subject.
“Thus the logical apparatus of universal prescriptivism, if we understand what we are saying when we make moral judgements, will lead us in critical thinking (without relying on any substantial moral intuitions) to make judgements which are the same as a careful act-utilitarian would make”. This is how “…the utilitarians and Kant get synthesized”.
In this way, Hare (1981: 42-43) reveals himself to be a utilitarian who has the categorical imperative as his safety net when confronted by those who would push him into the inferred immoralities of utilitarians who could seem to be obliged to murder one person to save the lives of two. When utilitarianism gets combined with the universalization principle, this challenge to utilitarianism falls away. (But Marinoff’s, 2004, reservation remains – that we actually do not know how to compute the greatest good of the greatest number!) Moreover, in the case of implementing professional codes of counselling and therapy research ethics, (as any other moral code) this amounts to saying: Try to promote the greatest good of the greatest number of individuals and/or groups; and harm nobody. (This will involve us in highly imperfect computations of inferred values of outcomes).
However, as indicated earlier, I also have decided to adopt the ethical guidelines outlined in Bond (2004b), which means that I’d better learn how to think as a rule-utilitarian, in relation to the educative principles, and as a prescriptivist (in relation to the imperative principles). Thus, I will treat the imperative principles in those guidelines as non-overridable; and the educative principles as overridable in a rule-utilitarian manner.
So Hare (1981: 87) is concerned with thinking about moral issues critically and rationally; and “…rationality is a quality of thought directed to the answering of questions…”. This is something I long ago deduced intuitively, and I have been striving in this direction throughout this paper. I have been struggling to formulate questions which would help me to think my way from my problem with my fourteen ethical dilemmas, or issues, to a solution which involves being able to make justifiable or defensible decisions with which I am emotionally and intellectually satisfied; and which are likely to satisfy the University of Manchester’s research ethics committee.
We now come to a major statement, in Hare (1981) that requires some analysis and clarification.
“We shall see that the method of critical thinking which is imposed on us by the logical properties of the moral concepts requires us to pay attention to the satisfaction of the preferences of people (because moral judgements are prescriptive, and to have a preference is to accept a prescription); and to pay attention equally to the equal preferences of those affected (because moral principles have to be universal and therefore cannot pick out individuals)".
Firstly, the idea that anything is “imposed on us” is a particularly opaque claim. There are, for example, amoralists: individuals who refuse to conform to anybody’s moral prescriptions, and thus it can be said that it is not easy (and certainly not effortless) to impose anything upon anybody, in a totally reliable way.
Nevertheless, we do have a number of psychological experiments – on conformity (e.g.: Sherif, 1935; and Asch, 1955: in Davies and Houghton, 1991 – pages 32-40); on compliance (e.g.: Bernstein et al, 1988; Freedman and Fraser, 1966; Deaux and Wrightsman, 1984: in Davies and Houghton, 1991 – pages 40-42); and on obedience (e.g. Bernstein et al, 1988; Milgram, 1963 & 1974; Hofling et al, 1966; and Zimbardo et al, 1973: in Davies and Houghton, 1991: pages 42-48) – which imply that we humans are particularly biddable and conformist. (Zimbardo’s research is, however, somewhat suspect: Banyard and Flanagan, 2005). Thus it seems that it cannot be mainly, or exclusively, “the logical properties” of something that imposes anything upon us, but rather (mainly) the “[logical] beliefs” of our earliest carers, and our most enduring social milieu; including our current social environment. Certainly, there seem to be (additionally) “categories of the mind”, as claimed by Kant – including inherent senses of space, time and causality. This view has been expanded and elaborated by Korzybski (1933) and Nierenberg (1982). These authors maintain that we have innate senses of structure, order and relations that we impose upon our sensate experiences of the world from the very beginning of our lives. (Nierenberg, 1982). This process precedes, or perhaps more accurately, facilitates, Piaget’s sensorimotor stage of learning: (Wood, 1988).
Thus, I am unwilling to go along with Hare’s (1981) inference that there is a kind of “objective imperative” that we adopt particular ways of thinking. I do not believe that this is the case. Rather there seems to be a “subjective sense of (logical) imperative” (derived from ‘sensibilities’, including empathy, and formal logic, that we’d better adopt some particular pro-social and generally life-affirming behaviours, and to exclude, as far as possible, the anti-social and the life-denying, otherwise we shall ourselves suffer the negative consequences of anti-social and life-denying attitudes. In other words, we have a sense that we had better pay attention to the preferences of others, in terms defined by them; otherwise they are unlikely to pay attention to our preferences; and may additionally penalize us for our wayward actions. But you have only to look at the average school playground to find mountains of evidence that, in the absence of social controls, there is a strong tendency among many (if not most/all) young humans to precisely give not one fig about the preferences of others (at least for much of the time). (Marinoff, 2004: 41). And that it is only through the successful socialization of the positive urges of the human heart that we arrive at “the logical properties of the moral concepts”, and normally as dogma rather than logical reasoning; though it can be supported by formal logical processes. That is to say, most humans have a single-level moral thinking process: they have moral intuitions that, if we (as a society) are lucky, they will normally follow. That seems to be it for most people.
Furthermore, it seems to me that all our logic systems are linked inexorably to our emotional systems, and that we are never “pure” in our logics, as a machine could perhaps be.
“To have a preference is to accept a prescription”, according to Hare, in the quote presented above. This is all too often and sadly true-for-individuals, as opposed to objectively true. Moreover, this seems to be the basis of most human disturbance. That is to say, people find they prefer X, and then they demand that they absolutely must get X, otherwise their life is awful, and hardly worth living. (Ellis, 1962, 1994). The X in this case can be long, red fingernails, a fast car, a job, a sex-love partner, or love and acceptance from others in general. Or almost anything else. However, is it true to say that, logically, and rationally, to have a preference is to accept a prescription? No, I do not believe it is. For example, I would prefer it if I looked like Michael Douglas, but would it be logical for me to turn this into a prescription: “I absolutely must look like Michael Douglas!”? Of course not. However, emotionally, most humans seem to be wired up in this way.
Moreover, we can fault this view by considering the question: “Is there any evidence that my preferences are valid imperatives?” Certainly, this seems not to be the case in the modal logical sense. Therefore, there seems to be a job to do here in extricating “morally logical (and therefore pro-social) decisions” from “illogical moral (and therefore neurotic) decisions”.
And just at this moment – noon, on Thursday 29th September 2005 - I had the breakthrough that I have been working towards for several months. I appreciated the following insights, which are all interrelated:
1. Hare’s (1981) arguments, while interesting, are laboured, exaggerated and faulty. His promised “method” is shallow and bitty. And although it advocates the “universalization” principle from Kant, it is far from being a universal system of thought about morality. It is a specific ideology. (And there are at least nine other moral ideologies, or systems of ethics. [Marinoff, 2004: 27-45]).
2. Hare (1981) is seeking what I was seeking – a method of reasoning about ethics and morality which is defensible, at the very least. However, we were probably both aiming beyond the defensible towards the “absolute”. Hard as it is for me to admit it, given that I am a relativist in relation to empirical enquiry, I seem to be driven by an absolutist urge towards certain knowledge in the moral domain. (This is probably a hangover from my absolutist moral education at the hands of the Catholic Church in Ireland, including having the De La Salle Brothers as my teachers!) (Marinoff, 2004: 46-53, posits meta-ethical relativism as a possible way forward, based on the use of several, or all, systems of ethics, as appropriate, without claiming that any one of them represents some kind of absolute truth).
3. It was this second point that made me realize that I was making the same mistake as Plato and Descartes (among the rationalists) and J.S. Mill and other scientists (among the empiricists), in thinking that it might be possible to develop a method of reasoning which can generate certain knowledge. I had better learn to settle for viable knowledge about human moral tendencies, and viable approaches to moral philosophizing.
4. I had not previously realized that I was seeking certain knowledge, since I know (intellectually) that morality cannot even be equated to ‘scientific’ knowledge – which is itself limited, propositional, hypothetical, and subject to challenge and change.
5. I was clear that Hare (1981) was elaborating a system of meta-ethics called “universal prescriptivism”, and I wanted to understand how I could master and apply such a system, to make this paper defensible. I had not realized until this moment that this quest was at odds with my ontology and epistemology, as outlined in an earlier document: (http://projectplanning2.blogspot.com). We seem to have innate tendencies, or urges, towards empathy and indifference, altruism and selfishness, and fairness/justice and unfairness/injustice. Additionally, we construct our moral philosophies based on our social “thrownness” - (Heidegger, 1927 [in Magill, 1982]) - group negotiations; and political impositions; rather than on the basis of pure logic or detached reason.
6. A moment ago, I realized that Hare (1981) is advocating a form of ‘foundationalism’ – Jamieson, 1993: 481-482 – which is akin to Descartes’ attempt to develop a ‘method’ of producing ‘certain knowledge’, by beginning from a secure ‘foundation’. Given my ontology and epistemology, I cannot go along with this idea. I suppose I will have to settle for ‘coherentism’ – Jamieson, 1993: 482. Both foundationalism and coherentism seek a defensible set of moral beliefs, as I do, but I am increasingly aware that I had better settle for ‘pragmatically defensible’, coherent principles, based on viable approaches, rather than a solid foundation, or a fundamental coherence, that puts my principles beyond challenge!
(All forms of foundationalism are susceptible to challenge and invalidation).
The first and most important pragmatic principle that I shall invoke is Heidegger’s concept of my ‘thrownness’: that is to say that I am thrown into a particular culture which already/always has a matrix of moralities/immoralities woven into it. Therefore, I inherit a system of morality in my encounter with my parents, teachers, and so on.
The second pragmatic principle that I shall use is that, by virtue of my work and my academic role, I am already/always under pressure to accept one or more of the ethical codes of the professional bodies that have produced research guidelines: (e.g. APA, CPA, BACP, BPS, etc.). And I choose to adopt Bond (2004b) as the core of my research ethics code, as modified by my personal morality, and my learning from my wider reading during the construction of this assignment. In particular, I will create a tension/fusion between Bond (2004b), McLeod (1994), and the BPS code (in Banyard and Flanagan, 2005).
As to Hare’s (1981) method of critical thinking, it amounts to no more than an amalgam of utilitarianism and Kant’s universalization principle. And, as I shall mention later, it is but one of a range of moral ideologies. It will be interesting to see if this approach helps me to think more effectively about my fourteen ethical dilemmas, or issues; and how it may be affected or changed by my consideration of other moral ideologies.
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5. Forsyth’s Work and Ethical Ideologies
Two days after I wrote the section above about my insights into Hare (1981), the latest tranche of articles (and one book), on the subject of ethics/morality, arrived from the Inter Library Loan Service (ILLS), and gave rise to these further considerations:
Forsyth (1980) presents four distinct ethical perspectives, or ideologies, one of which seems to be somewhat close, but still distinct, from Hare (1981). This one ideology, which seems similar to Hare, is called “absolutism”, and uses “inviolate, universal moral principles to formulate moral judgements”: (Forsyth 1980: 175). Although Hare (1981) begins from the utilitarian end of his model, and proceeds to the deontological (or ‘duty ethics’), the effect is to produce universal prescriptions, just like those of an absolutist in Forsyth’s (1980) taxonomy. The four ideologies identified, and investigated by Forsyth (1980), are as follows:
(a) Situationism: “which advocates a contextual analysis of morally questionable actions”.
(b) Absolutism: (as previously described).
(c) Subjectivism: “which argues that moral judgements should depend primarily on one’s own personal values”. And:
(d) Exceptionism: “which admits that exceptions must sometimes be made to moral absolutes”. (Forsyth 1980: 175-176).
It is not that Hare (1981) was unaware of other ideologies, and indeed he explicitly argues against subjectivism, naturalism and amoralism in developing his own model of moral reasoning. It is just that in attempting to elevate his own model above all others, he is in danger of misleading his readers. The specific misdirection could have been in conveying the illusion that humans mainly operate from “level one thinking” – or moral intuitions; which is probably normally correct - and that virtually all humans could learn to operate out of “level two thinking”, or reasoning from “universal prescriptivism” in choosing courses of action in difficult situations of conflicting principles. This would involve reasoning about consequences and intentions, but in a fundamentally absolutist manner – the imperative backstop. And this ignores the apparent fact that there are at least three other common ideologies, and that these are unlikely to disappear because Hare (1981) has advocated a single ideology.
So, at the very least, there seem to be four ethical ideologies, one of which, absolutism, seems close to Hare’s (1981) ‘universal prescriptivist’ approach. (Of course, Marinoff 2004 lists ten ethical ideologies, and accepts that this list is not exhaustive!) In an earlier paper, in 1978, “Forsyth … presents evidence suggesting that the ethical ideology people adopt influences their moral judgements”. (Forsyth, 1980: 182). However, strangely enough, the ideology they adopt does not reliably predict their behaviour! (Forsyth, 1980: 182). Therefore, there are probably about ten or more ethical ideologies, at least; and none of them probably significantly affects human behaviour, which seems to be more strongly controlled from the emotional/motivational level, and moderated by social contextual cues.
BACP (2006: 3) refers to “personal moral qualities”, which I want to distinguish from “moral ideologies”. Personal moral qualities seem to be “virtues or good personal qualities” which can be read from the individual’s behaviours. Of the ten moral qualities mentioned by BACP (2006: 3-4), I already had nine of them. The tenth one, Competence (in counselling research) was what was missing, and that is what I am trying to develop in this paper.
It also seems to be the case that individuals’ ethical ideologies change from context to context. This insight comes from my own experience of experimenting on myself. This came about because I have already used Forsyth’s Ethics Position Questionnaire (EPQ) which is used to allocate individuals to one of his four ethical ideologies. (To see a downloadable version of my EPQ, please go to http://www.rebt.cc/_wsn/page12.html. Then search for EPQ, using Internet Explorer
A major problem with Forsyth’s EPQ is that it polarizes individuals into absolutists and relativists, and this is probably an over-generalization. As indicated by Banyard and Flanagan (2005: 10):
“As always in these debates between two extreme positions, the common response is somewhere between the two. Most people who tend towards absolutism will allow for special circumstances and bend the rules on special occasions, while those who favour relativism are still likely to admit to some universal standards that form a ‘bottom line’ of behaviour”.
My moral judgements around my doctoral research will be largely defined by my personal values; and my recent self-education; and be further shaped and constrained and channelled by all those other agents with whom I am obliged to interact in the process of developing my doctoral research. And one of those agents is Bond (2004b). From Bond (2004b: 16) I take the injunctions that it is important that I am competent before attempting to conduct counselling research; that I am responsible for seeing to my own training; and that part of that training must include “…a thorough exploration of ethical dilemmas, and a review of practical strategies for addressing them”.
One way in which I can choose to express my agency is to set up a “tension” between Bond (2004b) and McLeod (1994), and see what comes out of that tension, in terms of my moral education and learning. This I propose to do by designing a matrix, with the main principles derived from Bond (2004b) on the Y axis, and the main principles derived from McLeod (1994) on the X axis. I will then look for cells in which useful comparisons and contrasts can be drawn, and see what I can learn from these interactions. I will attempt this in the next section of this paper. The purpose of this exercise will be to teach myself to think morally about counselling ethics, so that in Section 7 below, when I come to review the ethical issues or dilemmas associated with my original research proposal, I may have moral intuitions concerning counselling and therapy issues, rather than just concerning general social situations, which is what I have received from my moral education up to the present moment.
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6. Training Myself to Think Ethically about Counseling Research
I quickly got down to the task of creating the moral-matrix described above. The x-axis, across the top of the matrix, was derived from McLeod (1994), and the main elements can be seen here: http://moral-matrix-x-axis.blogspot.com/. The y-axis was drawn from Bond (2004b), and can be viewed here: http://moral-matrix-y-axis.blogspot.com/. (See Appendix A, below, for the first page of this matrix). I began to type the matrix on 1st December 2005, and began to type this section on 25th January 2006. All of the intervening time was spent “immersing myself” in ethical codes.
Here is a photograph of the top left-hand corner of the matrix, as it appears when assembled on a wall in my spare room:
Photograph 1: A corner of the matrix
And here is a photograph of the entire matrix to indicate the scale:
Photograph 2: The matrix is about five and a half feet high by three feed wide
As mentioned earlier, the matrix is constructed from principles and elements that I extracted from Bond (2004b) and McLeod (1994). And I have also consulted the BPS code: (Banyard and Flanagan, 2005).
There are 29 elements in the McLeod (X) axis; and 91 elements in the Bond (Y) axis, down the left hand side of the matrix. I have excluded one section from Bond (2004b), which is Section 3.5: ‘Research by practitioner providing a counselling or psychotherapeutic service’. I have taken this action because I am not going to conduct any research with my own clients. Therefore, I also omitted elements related to this subject from McLeod (1994). I then began to work my way through the matrix. Firstly I identified those cells in the matrix where there was some kind of tension or some kind of correspondence between the elements on the two axes. After a while I realized that I could spend a very long time doing this, since there are 2639 cells in the matrix! This seemed like an enquiry that was too broad and too laborious, relative to what it was likely to produce. So I tried to focus in on those principles in Bond (2004b) and McLeod (1994) that seemed (on the surface) to be more directly relevant to the 14 ethical dilemmas (that arose during my earlier study) that I am proposing to analyse and assess in the next section of this paper.
I have now reviewed all of the principles on both axes a total of 12 times since constructing the matrix. I also reviewed both sets of principles several times prior to that operation, in reading them, typing them, and reviewing them. We could therefore assume that I am now quite familiar with these principles. However, as a person with an MA in Education, which affords me some understand of how people learn, I have my own doubts about that! So I intend to continue this immersion process. This is about over-learning the principles of ethical functioning in counselling and therapy research. I have already had a very thorough education and training in general moral principles; but I have not so far had a sufficiently deep education in the specific ethical principles of counselling and therapy research.
One principle that does not appear on the wall-mounted matrix (although it does appear in Bond 2004b) is the recommendation to study the BACP code of counselling ethics. The importance of this action came out of a consideration of certain aspects of the matrix. The elements of the matrix have been abstracted from their source documents, and not every detail of both sources has been duplicated in the matrix. However, I assume that at least 90% of the key points of each source document has been transferred, on the basis of perceived relevance. And I have now also acted on the perceived importance of the BACP’s ethical framework for good practice in counselling and psychotherapy. (BACP, 2006). I have done this by reading BACP (2006) five times, taking notes as relevant, and reviewing my notes several times.
Anyway, before I reviewed BACP (2006), I decided to focus in on the kind of training, or immersion process, that I’d better put myself through (using my wall-mounted matrix) before I review the fourteen ethical issues or dilemmas in the next section of this document. And so on the McLeod scale (or X axis) I have identified eight elements (out of 29) that I want to review. These are numbered 4, 8, 9, 11, 16, 17, 19, and 25. And on the Bond scale I’ve identified twenty-seven elements (out of 91) that I want to review; and these are: 3(d), 4, 4(a), 6, 7, 8, 11, 13(a)(c)(d)(e)&(g), 20, 21, 22(a)&(b), 24, 26(a)(c)&[(d)(iv)], 27, 28, 31(a)(b)(c)&(e), and 35. So that means I am proposing to consider 27 times 8 elements = 216. However, as I began to work on this process, it became obvious that it was both excessively time consuming, and not well focused on the kinds of issues I want to explore.
My initial reaction is that, many of the problems that exist in considering the 14 ethical dilemmas (to be discussed in the next section) are not particularly well covered by either of these two ethical codes/guidelines: neither Bond (2004b) nor McLeod (1994); but this remains to be properly investigated and reflected upon later.
I then identified every “active cell” – where the selected X and Y elements converge – and began to explore those cells, to see which ones seemed most relevant. From that process I extracted 27 cells for particular scrutiny. What this meant in practice was that I explored the tension/convergence between the coordinates that produce these cells, and dictated my thoughts about them on to audio tape, which almost filled a 45 minute tape. I then listened back to my comments and thought about them some more.
In order to conserve space in this paper, I will list the details of those 27 cells at Blogger.com: http://appendixbfinal.blogspot.com/.
I have reviewed the tensions and convergences in these cells, and listened to my comments about them on audio tape. This was one form of immersion.
I have reviewed all of the elements on both axes of the wall-matrix (as reproduced at Blogger.com: http://yaxisofmoralmatrix.blogspot.com/ and http://the-x-axis-of-moral-matrix.blogspot.com/) more than a dozen times each. This has been another form of immersion.
I have gone back and re-read the BACP ethics code (BACP 2006) three more times, and incorporated my thinking about that document into various parts of this document. This has been a third form of immersion in the ideas and practices of counselling and therapy ethics.
I have also read Banyard and Flanagan (2005) - which is an elaboration of, and a discussion of, the principles outlined in the British Psychological Society’s code of ethics – in order to introduce additional tensions between some of these ideas; and incorporated my learning into this paper.
It is therefore now time for me to get down to the task of reviewing the 14 ethical issues in the next section, to see if I can demonstrate to myself and my readers that I have learned to think ethically about important issues of risk in counselling and therapy research.
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7. Risk Assessment: Involving 14 Ethical Issues
“The challenge of working ethically means that practitioners will inevitably encounter situations where there are competing obligations. In such situations it is tempting to retreat from all ethical analysis in order to escape a sense of what may appear to be unresolvable ethical tension. … No statement of ethics can totally alleviate the difficulty of making professional judgements in circumstances that may be constantly changing and full of uncertainties”. (BACP, 2006: 6)
Now that I have done a substantial amount of work on the background to ethical thinking, (20th February 2006), I want to review the notes I have taken (in my pocket notebook) on the fourteen ethical problems, or issues, that I have identified with my research project idea. My intention is to list all of these problems, and then to reflect upon them, and make some kind of risk assessment of each of them.
Initially my idea was to use Hare (1981), Bond (2004b), and my learning from the immersion process described in the previous section, to make it possible to think about these ethical issues.
However, having reviewed Marinoff (2004), I now intend to broaden that to include all systems of thinking encompassed in the concept of ‘meta-ethical relativism’. Meta-ethical relativism is not the same as ethical relativism. Ethical relativism holds that both the Nazis and the anti-Nazis were ‘right’, in terms of their own ethical systems. Meta-ethical relativism holds that all systems of ethical reasoning, (of which Marinoff lists ten such systems, and acknowledges that there are many more), are helpful in one situation or another. The art of moral reasoning is to choose the right ethical system to suit a particular ethical reasoning task. (Marinoff, 2004: 46).
Marinoff (2004) identifies three criteria to use in deciding whether a particular approach to ethical reasoning is suitable for a particular task. These are as follows:
“First, it must resonate with your moral intuitions. Second, it must mesh with your background experience of ethics. Third, it must help remedy the problem itself”. (Marinoff, 2004: 46)
These criteria indicate quite clearly that the task of moral reasoning is an imperfect art, and one that is situated in a particular culture, is peculiar to each individual within their culture, depends upon moral education and experience of moral reasoning, and involves judgements about what are and what are not viable solutions to moral issues.
Hope (2004: 59) adds another dimension to this approach, as follows:
“Everyone expects philosophical reasoning to be rigorous, to be logically valid. But what makes philosophy in general, and ethics in particular, so exciting is that providing reasons, and giving arguments, requires not only intellectual rigour but also imagination. Ethics uses many tools of reasoning, but it is not just a question of learning how to use the tools: there is always the possibility of a leap of the imagination – of a different perspective or an interesting comparison that puts the whole question in a new light and takes our thinking forward”.
My final observation, before proceeding to the work of risk assessment, is that I will be using the approach of the bricoleur – (McLeod, 2001: 119). And not just a bricoleur of the mind, but also of the heart, following Hope (2004: 6), who says:
“…although I believe in the central importance of reasons and evidence, even here the fox in me sounds a note of caution. Clear thinking, and high standards of rationality, are not enough. We need to develop our hearts as well as our minds. Consistency and moral enthusiasm can lead to bad acts and wrong decisions if pursued without the right sensitivities”.
Let us then test this thinking/feeling approach to meta-ethical relativism on the following fourteen issues:
1. If I were to draw my research participants’ attention to the ‘possibility’ of a ‘placebo effect’ having made some contribution to their therapeutic outcome, this could have the effect of causing them to lose faith in their therapy, which could cost them whatever placebo gain they made.
This was the first potential ethical problem that I identified concerning my research idea. Initially my response was apparent rationalization. It went like this: “Since I do not believe that the placebo effect is particularly significant in counselling and therapy, there is unlikely to be any real loss of therapeutic benefit. However, if I withhold the information about the nature of my study, participants will not know it involves some consideration of the placebo effect. Therefore, they cannot experience any loss of therapeutic benefit. I will inform them of the placebo consideration after the data analysis has been shared with them, during which they will almost certainly gain reinforcement of their belief in counselling and therapy. (That is to say, the research results are likely to show that individuals gaining positive outcomes from counselling and therapy did so as a result of identifiable “active ingredients”). After that point, learning that some authorities believe that the benefits of counselling and therapy could be primarily placebo effects – Horgan (1999) and Erwin (1977) – or even that “…the essence of good therapy … is placebo therapy…”: Griffin and Tyrrell (2004: 223) - is unlikely to have any significant negative effect on the participants”.
I no longer believe that this rationalization is acceptable, and I will discuss my new thinking here:
• Firstly, I do not believe it is okay to withhold the information from my participants that I am investigating some way to invalidate the proposition that their gains resulted from a pure placebo effect; even though this research cannot be conducted without withholding this information. (Banyard and Flanagan 2005:4; Willig 2001: 18; McLeod 2001: 197-98; Bond 2004b: 12-14).
• Secondly, withholding the information that I am trying to invalidate the placebo explanation would tend to undermine my trustworthiness in the eyes of the participants, and as such had better not be done. (Bond, 2004b: 10-11).
• Thirdly, one or more participants could be harmed by learning about the placebo explanation of positive outcomes from counselling, and as such it does not seem to me to be worth continuing if one person is to be harmed so that academic curiosity will be satisfied. Willig (2001) emphasizes that the only justification for deceiving the participants is (1) if there is no other way to get the research done, and (2) if the research outputs far exceed this cost. However, we have already seen from Marinoff (2004) above, that we have not one clue how to accurately or adequately weigh the costs and benefits of any particular piece of research! (That does not stop us trying, but we’d better be careful and cautious about it).
For these three reasons, I would not be willing to withhold the information that my proposed study is concerned with the placebo explanation for positive outcomes in counselling and therapy. And this probably compromises my research design to such an extent that the research idea as a whole becomes unviable.
2. It may be unethical to waste the time of research participants if we have good reason to believe that our research report or article(s) will never be read by our colleagues or peers.
In February 2005, I found and read Mair (1999), who quoted Mahrer (1998) as follows:
“Psychotherapists can be proud of their researchers because the researchers do not really bother practitioners much. Every so often researchers grumble that practitioners pay little or no attention to their findings, and they are right. In general, the practice of psychotherapy is essentially undisturbed by whatever researchers do. The practice of psychotherapy would probably be insignificantly different if researchers had instead spent their time playing volleyball. Precious little, if anything, of what practitioners actually do was given to them by researchers….It seems that researchers have an earned status of being essentially irrelevant, except that they help make the field look respectable”. (pp2-3).
This seems to suggest that I could be wasting my time running my research study, since it could be that practitioners are not particularly interested in the topic I intend to investigate. And, whereas it is up to me if I wish to ‘waste my time’ while earning a doctoral degree, it seems to me to be unethical to waste the time of my potential research participants, who would be asked to give up a good deal of their time and energy to produce the data that I would then analyze.
My original solution to this ethical problem was to consult colleagues about whether or not they would read my paper, and whether or not they considered it ethical to run my study, given Mahrer’s argument. (See my web log at http://justifyingresearch.blogspot.com, where I have posted my notes, resulting from an online survey of counsellors’ perceptions of this issue, and an attempt to write an article on this topic, (incorporating some notes by William West), which had to be abandoned because of time pressures).
Overall, consulting colleagues did not help me to resolve my ethical issues about wasting participants’ time, so I will now tackle that problem here, philosophically:
• On the face of it, it does seem both senseless and unethical to conduct research if few people are going to read the resulting report or papers. How can we justify the inconvenience to participants if nobody is waiting for the results to come hot off the printing press? And especially, how can we risk any harm whatsoever to participants if research reports are of such low import?
• The counter argument seems to be that counsellors “should care” about research activities. (BACP, 2004: 20-24). However, BACP (2004), which is an interview with three of the key players in research at the BACP, gets off to a bad start by justifying counselling research as follows: “In order to make counselling more widely available it has to be funded and the only way to attract funding is to persuade funders that counselling works”. Therefore, this argument implies, there is a “need” for a “research culture” among counsellors and psychotherapists. (BACP, 2004: 20). This is an opportunistic rather than a principled argument.
• Tim Bond (2004b: 10) has presented a principled case for conducting research in order to provide well-founded evidence as a basis for enhancing the “quality, effectiveness and safety” of the practice of counselling and therapy. From this he concludes that “Counselling and psychotherapy have a growing need for research-based knowledge”. (Bond, 2004b: 15).
• There is also a section in BACP (2006: 5) on ‘Maintaining competent practice’, in which it is said that: “A commitment to good practice requires practitioners to keep up to date with the latest knowledge and respond to changing circumstances. They should consider carefully their own need for continuing professional development and engage in appropriate educational activities”. This seems to justify the case for conducting research, even if currently the number of counsellors reading research studies is low.
• And again, in BACP (2006: 7), in the section on ‘Researching’, we find the statement that: “(BACP) is committed to fostering research that will inform and develop practice. All practitioners are encouraged to support research undertaken on behalf of the profession and to participate actively in research work”. Informing and developing practice is likely to benefit future clients, and prevent or reduce, or minimize, future harm. These benefits of counselling research are demonstrated in a recent article on eating disorders, in Counselling and Psychotherapy Research, in which it is shown that current thinking about eating disorders, which is widespread among counsellors, is inaccurate and unhelpful. Thus all counsellors who deal with eating disorders could benefit from reading the latest research. (Buckroyd, 2005). And this may apply to many other areas of counselling and therapy practice. This argument effectively scotches the reservations of Mair (1999), in that, although very few counsellors currently read research reports, there are very good reasons why they morally/preferably should.
This discussion has persuaded me that it would not be a good idea to refrain from engaging in research because of Mair’s (1999) objections. There are very good reasons to engage in research, and to try in every way possible to get the results of that research out to practicing counsellors and therapists: as argued by William West (http://justifyingresearch.blogspot.com).
3. It seems to be somewhat questionable practice to restimulate memories of pre-therapy unhappiness in research participants:
It occurred to me, when designing my research schedule of questions, that some questions, which ask the participant to recall what they felt like before counselling/therapy, might cause them to experience mild restimulation of negative feelings (or emotional suffering). (For schedule of basic questions, please see: http://jimsquestions.blogspot.com/) My idea of how to deal with such an eventuality, with any of my six respondents, was to offer counselling support myself, on the spot. However, Brannen and Collard (1982) say that “…the researcher should avoid being drawn into the role of counsellor”: (McLeod, 1994: 83). This discussion is presented by McLeod in the context of his awareness of “the potential to re-stimulate painful memories or unresolved emotional conflicts”: (McLeod, 1994: 82). Brannen and Collard’s solution was to have an observer present with the interviewer, and they found that “…the presence of the observer enabled (the respondents) to maintain a necessary sense of balance and containment in this highly emotional situation”: (McLeod, 1994: 83). However, I do not think it would be feasible for me to arrange an observer for my research project.
New critical reflection (23rd February 2006): Let us then consider the philosophical arguments on both sides of this issue.
• Firstly, it is fundamentally important to avoid harming research participants: (West, 2003: 267; Bond, 2004b: 14; BACP, 2006:1-2,7; BPS, 2000: 6).
• Secondly, agreeing to see a person as a client may cause them to bring up distressing material from their memory banks. Even grief counselling cannot proceed without stimulating grief. Therefore, it is not necessary to be a researcher to have this effect. It can and does happen in the helping relationships which characterize counselling and therapy.
• If we rule out the possibility of asking research participants about their pre-therapy lives, then we can only ask them about their in-therapy and post-therapy lives. However, their in-therapy lives may also have involved some distress or despondency, and therefore we would have to retreat into only asking former clients of counselling and therapy about their post-therapy lives. But without some indication of how their post-therapy lives compare with their pre-therapy lives, we cannot know how much or how little their lives have improved, if at all. Thus, if I outlaw my research proposal, I also have to campaign against all outcome research in counselling and therapy. Or at least, all qualitative outcome research in counselling and therapy. But that would put me in conflict with John McLeod (1994, 2001) who has called for the development of qualitative outcome research in order to put qualitative research on the counselling and therapy research map.
• Of course I have a choice here. I can follow people in the field, like John McLeod (1994, 2001), or Tim Bond (2004b), or I can take my own view, and decide that doing counselling research is too risky, in that it might cause pre-therapy unhappiness to be restimulated. However, if I take that view, then I must also face the implication that the gains of counselling and therapy seem to be so fragile and reversible that perhaps I had better stop charging clients for helping them to achieve such a fragile, temporary kind of improvement. But I have no evidence from my private practice that the gains of counselling and therapy are so fragile and reversible. Indeed, I see clients who worked with me years ago, and they still thank me for the gains they achieved, even though they almost certainly have had bad days in the interim during which they may have slipped back to their pre-therapy mode of functioning: or experienced some degree of the earlier dysfunctional emoting or behaving. Therefore I cannot accept that the gains of counselling and therapy are so fragile that they could be easily compromised by research questions, even in-depth probing by qualitative researchers.
• From the point of view of professional ethics (Bond 2004b, BACP 2006, BPS 2000), I must not harm a research participant. However, it is debatable whether or not restimulating some small amount of unhappiness is a form of ‘harm’ as such. According to my dictionary, (Soanes 2001) , ‘harm’ as a verb means:
o Injure;
o Have a bad effect on.
• Since I will be citing evidence later that counselling and therapy research often has positive effects upon participants, and I am arguing that the effects of restimulated unhappiness are likely to be very short lived, I do not think anybody could argue that a small amount of restimulated unhappiness could be classified as an injury. It is also not having a ‘bad effect’ upon the participant, on balance, and durably.
• Soanes (2001) cites three noun forms of the word ‘harm’:
o Deliberate injury
o Damage
o A bad effect
• If harm is about deliberate injury, then to deliberately make somebody unhappy is to harm them.
• My research is not designed to deliberately harm my research participants.
• Therefore my research design does not promote harm.
• I will not deliberately injure any of my research participants; and I have already shown that a small amount of temporary, restimulated unhappiness cannot be equated with ‘damage’ or a ‘bad effect’. And any short-term, temporary restimulation of unhappiness is likely to be counterbalanced by more significant levels of positive gain from the research interview experience. (McLeod 2001: 197).
• From the point of view of utilitarianism, I must not cause more harm than good: (Banyard and Flanagan, 2005). However, Marinoff (2004) argues that I cannot even begin to compute the amount of good or harm that I do. Nevertheless, it seems to me to be almost certain that, even if a few of my questions restimulate some pre-therapy unhappiness, this is unlikely to be intense or protracted. And it also seems likely that there will be emotional gains for the participants from participation in my research. (McLeod, 2001: 197). Therefore, even though I cannot accurately compute numerical values of cost and benefit, I can engage in conjectures about these likely effects.
• Pragmatically, it seems to me that most of my questions (in my interview schedule) are focussed on positive or neutral aspects of the counselling/therapy experience. Thus it is only in a few instances that clients might relive unpleasant pre-therapy emotions. However, I am in control of the interview, and I can choose to step back from exploring any ‘sore places’, and be sensitive to the participants’ emotional states. That would be a good example of ‘ethical mindfulness’ in practice - (Bond, 2004b) - to know that I can do harm as well as good, and to refuse to push into, or intrude into, sensitive areas.
• Thus, in relation to normally stable individuals, I would be willing to take the risk of restimulating a small amount of pre-therapy unhappiness or distress, which I would be sensitive about, and would not explore beyond the point of finding an obvious tenderness or soreness.
4. It is almost certainly indisputable that it would be unethical to restimulate memories of trauma in victims of trauma.
At the beginning of May 2005, I found a document (Pope, 1999) on the ethics of restimulating old memories of trauma, on the internet. This is it: Invited Guest Editorial: ‘The Ethics of Research Involving Memories of Trauma’, by Kenneth S. Pope (1999):
‘Informed consent and other ethical principles have long been fundamental to research involving human participants, as emphasized for example by the Nuremberg Code (2).
…
‘Newman, Walker, and Gefland's study … reminds us that not only are ethical considerations crucial to research in this area (of ‘false memory syndrome’ and sexual abuse), but that they may have additional implications. Informed consent, for example, rests on participants' ability to understand adequately the effects a research project may have on them. But as this study … found, some participants who have experienced major trauma may not realistically anticipate the distress such research can cause: "Not surprisingly, individuals with histories of maltreatment, especially sexual maltreatment, were more likely to underestimate their level of upset from research participation on both questionnaires and interviews."
‘Studies that invite participants to remember trauma may, as this study suggests, themselves be traumatic. As Primo Levi … wrote: "the memory of a trauma suffered or inflicted is itself traumatic because recalling it is painful or at least disturbing" (p. 24).’
It is my belief that these considerations are relevant to my research proposal, in that my interviews could restimulate memories of trauma in some of my research participants. Therefore, it seems to me to be unethical to allow any such traumatized individuals to take part in my research project.
Later critical reflection (25th February 2006): The question of restimulating memories of trauma is explicitly raised by Pope (1999), and in Newman, Walker and Gefland (1999). Pope (1999) concludes that “studies that invite participants to remember trauma may … themselves be traumatic”. Therefore, as a minimum, I would want to actively exclude potential participants who are consciously aware of having traumatic experiences in their personal history. This would include histories of sexual abuse, physical abuse, serious tragedies, accidents and natural disasters, and so on. Anything that would normally attract the label of “post traumatic stress disorder”, or some degree of that, had better be identified, and the potential participant informed of the very good reasons why they had better not participate in this research.
5. McLeod (1994) draws attention to the fact that qualitative research can normally be expected to be “painful and distressing”. This results from the depth of relationship established between researcher and research respondent in qualitative research, and the encouragement given by the researcher for the respondent “…to write or talk openly and honestly about themselves”: (McLeod, 1994: 167).
I do not know how to deal with this problem! (That was my view in July 2005). The only clue I have comes from Willig (2001: 79) where she cites Stake’s (1994) observation that: “Qualitative researchers are guests in the private spaces of the world. Their manners should be good and their code of ethics strict”. McLeod (1994) mentions that qualitative interviews call for detailed accounts of the experiences of clients. “What emerges for the informant may be painful and distressing, and it is the responsibility of the researcher to do everything possible to ensure the well-being of the person”. (e.g. Brannen and Collard, 1982): McLeod, 1994: 167.
However, I have my doubts about proceeding with this kind of enquiry, and I am therefore (29th June 2005) under pressure to focus on ethics instead, as my thesis subject.
Later critical reflection (27th February 2006): According to Bond (2004b) and BACP (2006), there is a real need for counselling and therapy research to establish an evidence base for professional practice. And Buckroyd (2005) has shown (using the example of eating disorder research) that current practice can be ineffective, or less effective than it could be, when it is not informed by recent, detailed research studies. Therefore, although there is a risk of causing some upset among research participants, it is not satisfactory to say that we will solve this problem by walking away. The challenge, it seems to me, is to stay with the research commitment, but to try to minimize the risk of causing upsets. In the case of extreme risk, as with traumatized individuals, it is important to exclude them. In the case of restimulation of unhappiness, it is clear that this is likely to be more than offset by positive gains from research participation. It is therefore in the middle ground, where “medium amounts” of research-related distress or disturbance are potentially liable to be caused, that we are obliged to “embrace these difficulties” and to work “in anguish”. (McLeod, 2001: 198).
6. There is an implicit contradiction, or an acute tension, between the apparent need to engage in some small degree of deception in connection with the purpose of some research projects, on the one hand, and the stressed importance of being trustworthy, and building a relationship of trust with the participant, on the others.
I had planned to withhold the information that I was conducting my research to try to invalidate the placebo explanation for positive outcomes in counselling and therapy, for two reasons. Firstly, to prevent harm to the participants’ placebo gains (if any); and secondly, to avoid creating the idea in the participants’ minds that I want them to look for ‘active ingredients’ other than a placebo type effect. However, Willig (2001: 18) specifies the rule that there should be “No deception”. “Deception of participants should be avoided altogether”. This seems quite clear, and very strong. She does specify one exception: “The only justification for deception is when there is no other way to answer the research question and the potential benefit of the research far exceeds any risk to the participants”. On the other hand, BPS (2000: 6) offered a different exception clause: “…the central concern (is) the reaction of participants when deception (is) revealed. If this (leads) to discomfort, anger or objections from the participants then the deception was inappropriate”. BPS (2000) also made a distinction “…between withholding some of the details of the hypothesis under test and deliberately falsely informing the participants of the purpose of the research”. I will have to consider how these ideas from Willig (2001) and BPS (2000) apply to my original research design, and then what to do about it.
Later critical reflection (27th February 2006): My research idea is designed to find out what people believe they got from their experience of counselling and therapy, and how they got it (in their opinion!) I would be hopeful that this study would reveal “active ingredients”, such as narrative change, re-parenting, change of beliefs/attitudes, etc. this (potential) discovery of active ingredients in the counselling/therapy experiences of six individuals, who had experienced six different forms of counselling therapy, could begin to challenge the idea – in Horgan (1999) and Erwin (1997) – that positive outcomes are a result of pure placebo effects. (However, a more thorough literature review might reveal that there is already evidence that positive outcomes in counselling and therapy are better accounted for by a variety of explanatory factors, including some small placebo effect; and that Horgan (1999) and Erwin (1997), are out of step with the majority of researchers on this subject).
It would not be dishonest to say: “I want to find out what you got from counselling/therapy” – and to omit reference to the placebo effect. This is an omission and not a deception.
When I wrote up my final report – if it proved to be relevant and appropriate – I probably would make reference to the placebo explanations of Horgan and Erwin.
Therefore, when this issue is considered from the point of view of deception versus omission, it seems okay to proceed with my research proposal. This is surprising since, when a different aspect this issue is addressed – namely the possibility of a loss of therapeutic benefit – I would not be willing to proceed.
7. If I don’t withhold some information about my goals in relation to invalidating the placebo explanation for positive outcomes in counselling and therapy, then the ‘demand characteristics’ of my study will probably induce participants to ‘find’ (or create) ‘active ingredients’. (This would affect not only the validity of my results, but also the integrity of my study).
Given that I believe the above statement (or believed it on 16th June 2005!), it seems to me that it would be unethical for me to proceed with this study, without withholding some information, since I know that giving the participants all of the information about the research design will enable them to ‘help me’ to produce the result that I ‘want’! I originally was concerned about this proposed withholding, because of the potential effect on the participants’ perceptions of my trustworthiness.
Later critical reflection (27th February 2006): I now think it would be okay to withhold this information, and reveal it in the first write-up of my research report, if appropriate. This is so because I have already established, in issue 6 above, that this withholding is about omission rather then deception. As such, I feel happy that I wound be out of integrity in withholding this information.
8. If I believe that people engage in ‘just so’ stories about their lives, including their experiences of counselling and therapy, and that their stories are not some kind of ‘objective truth’, but I report their stories as if they represent anything other than their ‘psychological reality’, then I am acting unethically.
If this statement is true, then what is the value of my proposed research study? I am going to spend a couple of years collecting just-so stories, based on fallible memories, and to shape them into a just-so story of my own, and present it as a picture of the ‘psychological reality’ of six individuals who have been through counselling and therapy. What is the value of this kind of activity? I just do not know.
Later critical reflection (27th February 2006): If I use this perspective to opt out of doing my research, then I had better also:
• Stop watching all TV shows, including the news, which are constructed by second-hand just-so stories.
• Stop reading all newspapers, magazines, books, and academic papers, all of which are constructed by individuals and/or groups, and are just-so stories.
• Stop talking to everybody, since everybody lives their lives inside of a set of stories they have inherited, co-constructed and self-authored.
• And, stop talking to myself, since I am an arch-story-teller.
To refrain from telling stories, and listening to stories, for a human, is to commit suicide. The art of living is to distinguish between stories on the basis of their ‘credibility’, or ‘viability’, or ‘social agreement’. The best stories are those that are evolved by social groups, and used by those groups to get things done socially.
My proposed research is as likely to attract six individuals who are plugged into useful ways of viewing themselves and their worlds as not. That is to say, I have about a 50:50 chance of getting six ‘good’ respondents who have something useful and interesting to say about their experiences of counselling and therapy. Allowing for the possibility that some of my participants may not be in a position to provide useful stories about their counselling and therapy experiences might seem to indicate the need for a slightly larger number of respondents. However, that then could tempt me to omit the ‘worst scripts’ which would be a form of distortion of the results that I found. So I will keep my fingers crossed – if I decide to proceed with my original research idea - that I get six individuals who are able to reflect upon their counselling and therapy experiences in a useful and productive manner, and provide some good, useful data for analysis. These data will take the form of subjective stories that tell us something about the personal experiences of those six individuals in relation to their counsellors, and their actual (phenomenological) counselling experiences.
9. An additional problem, when we get beyond the interviews with research participants, concerns the (psychological) effects on participants and third parties of what we write in our reports. “Smythe and Murray (….) discussed one pervasive risk factor in narrative research in terms of ‘the subtle and often unforeseeable consequences of writing about people’s lives’ (p. 321)”, according to Hadjistavropoulos and Smythe, (2001: 165).
One of the main problems mentioned by these authors is that, because of the perceived authority of the researcher/writer as an interpreter of the experiences of the participants, some participants may have negative emotional experiences arising out of introjecting the interpretations and judgements of the researcher/writer. They cite a study by Josselson (1996) in which one of Josselson’s participants felt that one of Josselson’s interpretations of the participant had “…put a definite constraint on his subsequent interactions with others”. Josselson went on to describe this outcome as the participant “…feeling that I had invaded him – and in a way that he had not felt about his analysis. I had captured him in a category that he could either explore or escape from, but it was a cell that bounded how he could think about himself”: (Hadjistavropoulos and Smythe, 2001: 165).
Hadjistavropoulos and Smythe, 2001, commented further: “If the participant in this instance, himself a psychologist and psychoanalyst, was affected to this extent by the researcher’s authorized interpretations of his experience, the effect on the average person would likely be much greater. One should not underestimate the subtle risk factors entailed by this form of authoritative reinterpretation of experience”. (Page 165).
Later critical reflection (27th February 2006): I am proposing to study the effects upon participants of engaging in counselling and therapy processes. To that extent, my research is likely to be about what the therapist did, said and so on, and upon how the clients’ lives changed from before to after therapy. Thus I will not be focused upon any form of categorizing or classifying of the behaviours or traits of the participants. For this reason, there will not be any categories in which participants could find themselves trapped.
10. Hadjistavropoulos and Smythe (2001: 165) draw attention to the danger of individual participants, or third parties, in written narratives, being identified: “Qualitative research frequently involves the use of narratives derived from very small numbers of participants. Such narratives often appear verbatim in publicly accessible documents such as theses, dissertations, and published articles. … the increased risks of qualitative research are largely the result of the public availability of such narratives and of the possibility of identifying the participants as well as third parties mentioned in the narratives”.
I am now aware of this problem, and would want my participants to also understand it. I would want my participants to read the first and final drafts of my research reports, so that they can see what is being said about them, in however anonymized a form it may be. I would also want them to project themselves into a future in which this report is available to some sections of the public, in the form of a library-housed report, or in a professional journal. If they have any significant problems with that imagined future scenario, in terms of the exposure of identifiable individuals, then I would not proceed with my publication in that existing form. I would want to renegotiate it until the participants were happy with the result: even if this involved producing an explicitly fictionalized account (McLeod, 2001); or until I decide to abandon it altogether.
11. Risks to unidentified depressed clients: Hadjistavropoulos and Smythe (2001: 167) point out that: “It is not difficult to imagine a situation in which a research participant who (possibly unbeknownst to the researcher) suffers from major depression and participates in a study that involves a narrative about his or her life’s experiences. In the course of the interview, a negative social experience could exacerbate the negative mood state of the already depressed participant. The relatively unstructured nature of qualitative research would allow for the possibility of topics of discussion that induce negative mood states. … Qualitative interview procedures in particular have the potential to re-evoke painful memories or emotional conflicts for participants both during the interview and afterwards …”
This is a difficult problem, precisely because it is about ‘unidentified depressed clients’. Is it likely that an unidentified depressed client would come forward to tell about their positive outcomes from counselling and therapy? Perhaps. Perhaps not. If such a danger is assumed to be possible, then it would be important to check all offers to participate in the research, by administering a recognized depression inventory (Beck, Burns, etc), so that we have the maximum chance of eliminating any depressed individuals from the research.
But what about any individual who gets through this test, and then becomes depressed at some point during the interview? That would be covered by the “consent as process” approach, whereby participants would be informed that they have the right to withdraw at any time; and I would check their willingness to remain in the research after every third or fourth question-theme (which would include sub-questions that arose spontaneously during the interview). In this way, I would hope to keep depressed clients out of the study, and help individuals who become depressed during a particular question to recognize that they have the right to opt out at any time.
12. There are other similar but distinct problems, which are also addressed by Hadjistavropoulos and Smythe (2001). For example: “…it is possible to encounter individuals suffering from undiagnosed conditions who engage in a variety of defensive strategies (e.g. avoidance coping) or are unaware that they have a serious psychiatric disorder. This unawareness is likely to exist for both the researcher (interviewer) and the participant. Extensive questioning could undermine these defensive strategies and cause decompensation by leaving the person to bear the full emotional brunt of the underlying maladjustment”. (Page 167).
This is a very serious problem, and one that is likely to be managed ‘in anguish’. In some forms of research, this would be a very onerous problem – especially interviews about the person’s traits and behaviours, and how they manage their relationships, and so on. However, in my research, which is about what they got from their therapist, and how they changed, or what they gained from pre- to post-therapy, this is not likely to be a major problem.
13. There is also a problem with ethical controls, according to Hadjistavropoulos and Smythe (2001: 167-168), as follows: “In qualitative research, …, the exact nature of the questions often is undetermined, and risk may be more significant. If the qualitative researcher is intent to reach a certain depth of information or disclosure without specifying the questions to be asked, no independent ethical body can verify whether the questions posed are reasonable or appropriate”.
This is a very real problem. I have displayed the kind of question themes that I am going to use, here: http://jimsquestions.blogspot.com/. However, within each question-theme, I would hope to be able to identify new areas to discuss, as and when the respondents provide answers to the theme-questions. How can I reassure my supervisors, and myself, that I will act in a responsible manner in carrying out these discussions? Let us take three of my questions at random and consider this problem in relation to each of them in turn. I will choose numbers 8, 17 and 26, without knowing what they refer to. (It is many weeks since I wrote my interview schedule, and mostly it has drained from my accessible memory banks). I will now find them (on file) and display them here:
Q8a: How contented or discontented were you before counselling and/or therapy? (Prompts: Did you think your life was pretty comfortable and pleasant? Did you count your ‘blessings’, no matter how limited? Or did you lament the restrictions, frustrations or difficulties in your life? Did you trim your desires to fit what was possible, or did you have goals that could hardly be reached?)
Firstly, this is one of those questions that might conceivably bring up some pre-therapy unhappiness. The ‘prompts’ indicate the general areas of questioning that I want to pursue. In probing any responses, I would apply the principles that I established in connection with issues 3, 5 and 11 above. Although I do not know what follow-on questions I am likely to ask in each interview, I am committed to being sensitive to the participants’ needs, to want to avoid unnecessary probing of their privacy, and to promoting consent as a process, including the right to opt out if the process becomes too painful.
Q17a: How much meaningful activity do you now have in your life, since completing counselling and therapy? (Prompts: List the types of personally meaningful activity you have in your life. Examples: Family activities; meetings with friends; work/career; church or club activities; education or leisure; etc.)
Again, this is a question that could conceivably cause a participant to become upset, if they have not got a particularly meaningful life, in their own terms. But this upset is more likely to be of unhappiness rather than extreme distress. And in many cases participants are likely to have new meanings in their lives, and are likely to enjoy the opportunity to discuss them, and may even gain insights into the ways in which these meanings have evolved over time. (McLeod, 2001: 197).
Q26a: What was it about your relationship with your counsellor/therapist that most helped you to make positive gains/changes? (Prompts: Qualities? Stances? Attitudes? Values? Statements?)
This question is more typical of the majority of questions in my interview schedule. That is to say, they mostly do not focus on the participant, but on some aspect of the process of counselling/therapy that they experienced. And again, this question focuses on positive outcomes. It is difficult to imagine anybody becoming even mildly unhappy about any aspect of this question. And even though we do not know what follow-on questions I would develop on the spot, we can be reasonably confident that:
1. They would not focus on sore or sensitive aspects of the participant’s memory;
2. They would be most likely to focus on aspects of process;
3. They would be constructed with sensitivity to the needs and interests of the participant uppermost in my mind.
14. The final point made by Hadjistavropoulos and Smythe (2001: 168-170) concerns more general damage to third parties, which might have legal, and other, consequences. “Narrative discussions about third parties could be damaging to such persons who never consented to participate in the research. In terms of realizing an element of risk, the participants should be aware that such third parties may not only become angry at the participants, but also could sue them for defamation and perhaps even violation of privacy. Ethical and legal issues become intertwined in this example”.
These authors go on elaborate this point as follows: “In the small sample of theses we examined, for example, there were frequent references to family and marital difficulties; money and employment problems; dating and relationship issues; health problems; drug and alcohol abuse; verbal, physical and sexual abuse; unethical and illegal activities; professional misconduct; and more”. … “…the use of pseudonyms offers insufficient protection when the narrative information provided by participants is so detailed that the third parties involved would easily recognize themselves in the transcripts (or would be recognizable to others who know them)”. … “The main ethical problem stems from the fact that these individuals did not give consent to have stories about them circulated in this way (i.e., in a public document), and research participants generally are not authorized to give consent on behalf of the other individuals they may happen to mention in their narratives”.
The relevant third parties in my study include:
1. The counsellors/therapists who helped the participants.
2. The partners, spouses and other family members of the participants.
However, it is unlikely that any narrative that I will produce will contain any stories about those individuals – except for the counsellors/therapists.
How can I protect the interests of the counsellors/therapists named as third parties in the narratives of my research participants?
1. Make sure they and their practice locations are not named.
2. Make sure nobody can infer their identities from features of the story.
3. Make sure that, if point 2 is not possible, then the story is explicitly fictionalized.
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8. Conclusion
This doctoral assignment paper describes a long and difficult journey from moral dogmatism to ethical thinking and moral reasoning in counselling and therapy research issues.
Although I was not clear about this at the start of the process, the final culmination of my journey is a risk assessment exercise, which looked at the fourteen ethical issues that arose in connection with my original research project idea.
That risk assessment exercise is summarized and concluded below. Against each ethical issue, I make a final judgement as to whether to proceed, to proceed with caution, to avoid particular types of potential participants, and/or not to proceed.
ETHICAL ISSUES RISK ASSESSMENT
1. Negative, counter-therapeutic effect of discussing the placebo possibility. This could prove harmful for one or more participants. For this reason, I would not be willing to proceed, unless I can withhold this information successfully. (DO NOT PROCEED).
2. Wasting participants time if counsellors don’t read my published report of my study. There is no real risk to participants here, and no good reason to refrain from proceeding, given that counselling and therapy need more good quality research. (PROCEED).
3. Potentially restimulating memories of pre-therapy unhappiness. This does not amount to injury, harm or a bad effect. It is a low risk of temporary, transitory unhappiness. (PROCEED WITH CAUTION).
4. Possibility of restimulating memories of trauma. This is a high risk to specific types of individuals, and necessitates the conscious and deliberate exclusion of potential participants who have experience of traumatic events in their lives. (DO NOT RECRUIT TRAUMATIZED APPLICANTS).
5. Qualitative research can be expected to be painful and distressing. I feel obliged to embrace this difficulty and work “in anguish”; trying all the time to minimize the risks. (PROCEED WITH CATUTION).
6. Withholding information threatens perceived trustworthiness. I am proposing to omit references to the placebo explanation until the discussion of the draft report. This does not seem to me to impact my trustworthiness. (PROCEED).
7. Withholding information in order to manage the demand characteristics of my study. I think it would be okay to withhold the information about my interest in the placebo explanation. This could be revealed at the time of sharing the first draft of my report with the participants. However, even at this stage, one or more of the participants could be harmed by this revelation. (ISSUE 1 RETURNS. DO NOT PROCEED).
8. People engage in ‘just so’ stories, and present interpretations of their experience as ‘facts’. I have a 50:50 chance of getting six ‘good’ respondents who have something useful and interesting to say about their experience of counselling and therapy. (PROCEED WITH CAUTION).
9. An additional problem, when we get beyond the interviews with research participants, concerns the (psychological) effects on participants and third parties of what we write in our reports. This in unlikely to be a particular problem with my research proposal; although it is important to make sure I am careful in this respect. (PROCEED WITH CAUTION).
10. Danger of participants or third parties being identified: (broken promise of confidentiality/anonymity). If my participants have any significant problem with my draft report, in terms of imagined future exposure of identifiable individuals, then I would not proceed with my publication without significant changes, including the possibility of an explicitly fictionalized account. (PROCEED WITH CAUTION).
11. In the course of interviewing, a negative social experience could exacerbate the negative mood state of an already depressed participant. All volunteers to participate in my research would have to be screened using recognized depression inventories. (DO NOT RECRUIT DEPRESSED APPLICANTS).
12. Extensive questioning could undermine the defensive coping strategies of an individual with a psychiatric disorder, leaving the participant to bear the full emotional brunt of their underlying maladjustment. Because my research will focus on what the participants got from their therapy, and how they changed, this is not likely to be a significant problem. (PROCEED).
13. My general areas of questioning are known, but my supplementary questions cannot be known in advance. However, we do know they would focus on aspect of counselling process, and be constructed with sensitivity to the needs and interests of the participants. (PROCEED).
14. Damage to third parties. I will protect the identities of the counsellors of my participants at all costs. (PROCEED).
Of the fourteen issues in my risk assessment exercise, I conclude as follows:
• Issues 2, 6, 12, 13 and 14: It seems okay to proceed.
• Issues 3, 5, 8, 9 and 10: It seems okay to proceed with caution.
• Issues 1 and 7: It seems inappropriate to proceed. Do not proceed.
• Issues 4 and 11: Do not recruit traumatized or depressed applicants.
Because of issues 1 and 7 in particular, combined with seven “proceed with caution” decisions, I think it appropriate that I not proceed with my original research project design. My overall reasoning is as follows:
1. The small risk to one or more participants, of informing them that some authorities believe the whole of their positive outcomes from counselling and therapy have been the product of a pure placebo effect, could have the effect of reducing or eliminating their therapy gains, by reducing or eliminating their belief in their treatment.
2. Because I have spent two years of research getting to this conclusion, I have also used up much of my research time, and judge that it would now be more realistic for me to build a small research study on the back of my ethics research so far.
3. I therefore propose to drop my original idea, and to develop an action-research study which will focus upon the teaching and learning of ethical reasoning among doctoral candidates engaged in counselling research.
Jim Byrne
26th April 2006
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PRINCIPLES AND PROPOSITIONS =======================
Tim Bond in vertical column John McLeod in top horizontal row 1. Participant confidentiality 2. Informed consent 3. Voluntary participation 4. Not causing harm to participant 5. Promoting wellbeing of participant 6. Respecting right of p to take responsibility for self 7. All ps treated fairly and justly 8. Research designs are never ethically neutral
1. Baseline issues/public safety/musts
2. Above minimum level/more educative voice/mindfulness
3. Trustworthiness/quality of relationships/integrity
3a. In relationships with participants
3b. Discovery/construction of new knowledge
3c. Application of research to practice.
3d. An active sense of ethical responsibility
4. Careful consideration of risks
4a. To participants/self/others
4b. To the integrity of the work
4c. Withholding information from participants (not good)
5. Consult others before proceeding/supervisor/host institution/user groups etc
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For further information, please contact Jim Byrne at ABC
Coaching and Counselling Services.
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