Transcript Psychotherapists’ handling of sexual attraction to clients

Psychotherapists’ handling of sexual
attraction to clients: A grounded theory
Anthony Arcuri – UNSW
QHeRC Meeting
8 April 2008
Background
• A poorly developed literature
• RQ: What is the process of
psychotherapists’ handling of sexual
attraction to clients?
• Method: Grounded theory
– Generator of theory “where existing theory
is inappropriate, too abstracted, or absent
entirely” (Henwood & Pidgeon, 2003, p. 134).
What is a grounded theory?
• “Derived from data, systematically
gathered and analyzed through the
research process.” (Strauss and Corbin,
1998, p. 12).
• Aim “is to produce innovative theory that
is ‘grounded’ in data collected from
participants on the basis of the
complexities of their lived experiences in
a social context.” (Fassinger, 2005, p. 157).
The research process
• Step 1: Articulate own conceptual
framework
• Clarify ‘sensitising concepts’. Helps:
– Minimise / remain sensitive to bias (bracketing)
– Self-reflection / reflexivity
– Reader judgement
• My sensitising concepts:
–
–
–
–
constructivist paradigm
training and practice as therapist
prior knowledge of literature
belief that SA acceptable
Step 2: Ethical considerations
• ‘Trustworthiness’ (Haverkamp, 2005)
• Ethics committee
• Therefore, exploration of hypothetical,
rather than actual, accounts of sexual
attraction
– Pros: less threatening, perhaps more
trustworthy.
– Cons: is a hypothetical account an adequate
substitute for experience?? Will the data be
less rich??
Step 3: Sampling
•
•
•
•
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Psychologists who practice psychotherapy
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36 responses – screened for suitability
First participant recruited purposively
Subsequent participants – theoretical
sampling
Example of theoretical sampling
• Early concept: Self-disclosing sexual
attraction to client
• Theorised to be influenced by the
therapist’s theoretical orientation –
participant said she might because of
psychodynamic background
• So, sampled therapists with different
theoretical orientations – CBT, systemic,
narrative, mixed – to see if they would or
wouldn’t based on their backgrounds.
Step 4: Interviews
• 11 interviews in total
– 6 men, 5 women
– Mid-twenties to mid-sixties; 1-40 years’
experience
– Range of theoretical orientations
• Small number, as intended to represent an
experience, not a population
• Interview guide – ever-changing, based on
emerging concepts, but open to new
concepts
• Interview process – talking about sex with a
stranger in a closed room
Step 5: Data Analysis – Open and
Axial Coding
• Open coding – identifying concepts, and their
properties and dimensions
• Axial coding – relating concepts to each other
on basis of their properties and dimensions
– Using a ‘paradigm’
• Conditions  actions/interactions  consequences
• Some grounded theorists opposed to this
• My adapted paradigm: Conditions  considered
actions/interactions  expected consequences  actual
actions/interactions  actual consequences
– Provisional hypotheses
Example of Axial Coding
• Psychotherapists are likely to deem mutual,
highly intense sexual attraction to clients
(characterised by preoccupation, anxiety and
guilt) unmanageable, and thus decide to
discontinue psychotherapy with these clients
to prevent negative consequences (loss of
objectivity, sexual contact).
• Categories highlighted in bold, their properties
underlined, and their dimensions italicised
Data Analysis Cont’d – Coding for
Process and Selective Coding
• Coding for process – identifying
sequences of action/interaction
• Selective coding – integrating and refining
theory
–
–
–
–
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Theoretical saturation
Storyline
Diagrams
Sorting and reviewing of memos
Writing the grounded theory
Step 6: Reliability and Credibility
Checks
• Independent coding by supervisor
• Internal consistency, completeness and
logical progression
• Credibility
• Some participants commented on
‘storyline’
A grounded theory
Awareness of options for handling
the sexual attraction
- Management of the sexual attraction
- Therapeutic use of the sexual
attraction
- Guidance seeking
- Privileging the sexual attraction
- Discontinuation of psychotherapy
Psychotherapist’s characteristics
- Combined personal and
professional identities
- Maturational characteristics
- Psychotherapy training history
- Theoretical orientation
- Relationship status
- Gender
Development of sexual
attraction to a client
- Client’s characteristics
and behaviours
- Psychotherapist’s
characteristics
- Process of the
therapeutic relationship
Phenomenon of sexual
attraction to a client
Assessment of the consequences and
ethicality of options for handling the
sexual attraction
Appraisal of the sexual attraction
- Intensity
- Degree of interference with
psychotherapy
- Mutuality
- Client’s characteristics
- Timing
- Reasons
Consequences of the implemented
action
- Cessation of psychotherapy
- Continued therapy with incompletely
or unsuccessfully managed sexual
attraction
- Continued psychotherapy with
managed sexual attraction
Decisions regarding the
handling of the sexual
attraction
Perceived manageability of the
sexual attraction
Implementation of the
chosen action
Limitations
• Me – style, bias
• Hypothetical rather than actual accounts
• Some poorly developed concepts due to
above
Some highlights
• First theory of its kind
• First identification of:
– Intensity as important component of the
sexual attraction
– Dilemmas involve in referral to other
practitioners
– Clear barriers and facilitators to guidance
seeking
Discussion questions
• How does theorising differ from generalising?
• How should one handle highly sensitive or
potentially illegal information disclosed in a face-toface interview? How about in a focus group?
• How much of a grounded theory comes from data
and how much from the researcher? What is an
optimal balance that ensures the integrity of the
research?
• How flexible are qualitative methods? Should one
follow guidelines closely, or adapt methods to one’s
own approach?
• Are hypothetical accounts of phenomena worth
investigating?
References
Fassinger, R. E. (2005). Paradigms, Praxis, Problems, and
Promise: Grounded Theory in Counseling Psychology
Research. Journal of Counseling Psychology, 52(2), 156-166.
Haverkamp, B. E. (2005). Ethical perspectives on qualitative
research in applied psychology. Journal of Counseling
Psychology, 52(2), 146-155.
Henwood, K., & Pidgeon, N. (2003). Grounded theory in
psychological research. In P. M. Camic, J. E. Rhodes &
L. Yardley (Eds.), Qualitative research in psychology:
Expanding perspectives in methodology and design (pp. 135155). Washington: American Psychological Association.
Strauss, A., & Corbin, J. (1998). Basics of qualitative research:
Techniques and procedures for developing grounded theory (2nd
ed.). Thousand Oaks: Sage Publications, Inc.