The challenges of training in research and practice?

The challenges of training in research and practice? A cup of coffee with Nick Midgley

Isabel: I was recently asked to deliver a talk about the challenges of training people to be both practitioners and researchers in counselling psychology, which I found an interesting question… So I thought I would ask about your experience of that, coming from a different but perhaps quite similar field, which is child psychotherapy. Would you be able first of all to say a little bit about the field of child psychotherapy, and perhaps from your perspective what some of the similarities might be to a training like counselling psychology?

Nick: I don’t necessarily know what the similarities and differences are, but child psychotherapy is a four–year training, and I suppose in terms of its history, what is interesting is that it is not a branch of psychology training, and the training also didn’t develop in the context of universities. So all of the trainings that developed were offered by independent organisations, and were seen as practice trainings, it was about the craft of being a practitioner. And being a psychoanalytic training, they fundamentally followed what was set up in Berlin in the 1920s – which was that there are three elements to training – one is your own analysis and self-development, one is seminars and reading psychoanalytic texts, and the third is supervised practice. That was how the first training was set up in the 1920s and child psychotherapy training in the UK has effectively followed that same model, really until the last ten years or so.

So initially it wasn’t considered to be a research training, or to have research in it. There wasn’t an expectation to do research or learn anything about research methods. In fact, there was quite a heavy suspicion of research, which again to some degree went back to the early psychoanalysts, who felt, possibly quite rightly, that academic psychology of their day had not much to offer them, and that academic psychology was positively hostile to psychoanalytic thinking. So psychoanalytic thinking in a way developed outside mainstream academia, and didn’t feel that scientific methods could necessarily capture the kinds of things that psychoanalysis was interested in.

Isabel: So it was research in the consulting room… and Freud’s statements about that?

Nick: Yes, exactly. I think the one exception to that in child psychotherapy is developmental research. So people have been reading Bowlby, they have been reading Daniel Stern, they have been reading Colwyn Trevarthen. They are researchers – they’re not psychotherapy researchers, but they are child development researchers. And I think they have been of enormous interest to child psychotherapists.

And in a funny way, neuroscience research has been something that some child psychotherapists, even if it is not part of the training, have got very excited about. Although often it’s about when the neuroscience seems to confirm our ways of thinking. Allan Schore is probably the person who has been the most influential. And of course, his ideas go quite a long way beyond what psychoanalytic thinking has said, but I think a lot of it has been a kind of a confirmation of our thinking.

Isabel: I suppose as a starting point that’s one similarity with counselling psychology. Although counselling psychology did develop within universities, and it is a psychology training, or an applied psychology training, certainly up until 2009, it wasn’t a doctoral training. It was an MSc, so there was a dissertation element, but the place of research within counselling psychology up until 2009 was more limited. And I think you could say the arrival of the doctoral training has brought with it quite a lot of debate and to some extent challenge. I am wondering how that’s gone in child psychotherapy?

Nick: I think yes, it is similar – it has only been fairly recently that child psychotherapy has become a doctoral training. I think probably the impulse behind the doctoral training related to particular aspects of research – outcome research and evidence-based practice. There was a feeling that there was a risk to child psychotherapy if it didn’t have an evidence base, if there wasn’t that kind of proof of its effectiveness. Whereas for a long time, people had just felt “Well, that doesn’t matter to us, because that isn’t the kind of evidence that is meaningful to us”. So I think part of the ambivalence about research and also about the doctoral training, is that it has been less a matter of people wanting to have a research element, as feeling we need to have a research element. And it’s interesting, often when you mention research in this context, people don’t think of developmental research, they think of outcome studies. They just assume that if you say the training has got a research element, you’re really just meaning quite a narrow idea of what research is.

Isabel: I am quite interested in… when you say that there was this perceived need for evidence, in concrete terms, how the child psychotherapy trainings became doctoral – like who decided and how did it actually come about?

Nick: Well, I can answer that in two slightly different ways. One is that there is still a gap, which may not be true for counselling psychology. The requirements to become a child psychotherapist, which are set by a professional body, don’t actually include any research training. So, in fact, you don’t need to do a doctorate to become a child psychotherapist. There is still one child psychotherapy training that has chosen not to become a doctorate – and you can still qualify as a child psychotherapist. But it does mean, which is slightly odd, that the trainings that have become doctorates, the element of the doctorate that is the research, actually isn’t a requirement. So you could do all of the other bits and not do the research bit and still qualify.

Isabel: Ah so it’s optional?

Nick: At a very fundamental level, it’s optional. And linked to that, when the trainings became doctoral, which again I think is different to counselling psychology, the bulk of the trainings continued outside of university settings, then students would do some additional teaching, often in a different institution, which was the research teaching. And so quite often people would say “I am doing a child psychotherapy training and a doctorate”. They would think of the child psychotherapy training as everything they did clinically, and then the doctorate would be the seminars they had in research methods and the dissertation they wrote. But in the training that I am involved in [at UCL and the Anna Freud Centre, working with the British Psychotherapy Foundation], one of the things we do is to say this is not a training and a doctorate, this is a “doctoral training”.

Isabel: So to integrate more?

Nick: To integrate more. And, to be clear, which is the case, that when the trainees are on their clinical placements, to when they have a seminar about Freud, when they have a seminar about research methods, that’s all the doctorate. And, that sounds fairly obvious, but actually it’s not – even some of the people who teach on the training don’t see it that way.

Isabel: Well I suppose in the context that you’ve just described, that makes sense that it wouldn’t automatically be understood like that.

Nick: And even in our training, quite literally, the trainees go to one place, the British Psychotherapy Foundation, for their clinical seminars and they come to the Anna Freud Centre for their research seminars, so there’s still a separation there in location and teaching staff. I am the only child psychotherapist teaching on the research side, because there are very few child psychotherapists with the research skills to be able to teach the research side of the course. But before this course, if you were on a training, you would finish your clinical training, and then spend a couple of years, post-training, doing your doctorate. We were the first course to say no, the four-year training is the whole thing. To try and again make it a bit more of an integrated thing.

Isabel: And what was the motivation to make it more integrated?

Nick: It was a mixture. It was partly pragmatic. Trainees were doing a four-year training, qualifying, getting jobs and then being told, in your spare time, just carry on doing your research. And often they would drop out four or five years’ later.

Isabel: So research is at the end of everything that sort of gets left, and doesn’t get done…

Nick: … and life gets started, and you’re no longer in a training. So pragmatically that wasn’t a good approach. And I think it left the research as something separate, you were a child psychotherapist and you did research. The research was something that could be added on later, rather than being seen as a core part of the clinical training. And so I suppose I would slightly challenge the way you first framed this discussion, “the challenge of training people to be both practitioners and researchers”. I don’t quite see it that way. I think it is the “the challenge of training people to be practitioners”, and part of training people to be practitioners is the research element. That in a sense we need a range of skills to be counselling psychologists or child psychotherapists. We need the skills to be able to work in the transference, we need the skills to be able to work with a multi-disciplinary team, we need the skills to be able to draw on research evidence, we need the skills to be able to work with parents, we need the skills to be able to critically engage with empirical research findings. Those aren’t about being a practitioner and a researcher, but actually about the kind of practice and practitioners that we need to be nowadays. We are better if we are research-informed, and research-literate.

I guess also, being a good practitioner is also being curious about the mind, and trying to understand the mind, and trying to understand development, and trying to understand relationships. And having experience of conducting a piece of research is one way of learning a disciplined way to be curious, and skills to learn, and skills to explore things, and skills to challenge your own ideas – those seem important skills to have.

Isabel: Yes. That is what I was going to say, that being research-informed is one thing, but that’s a different thing from why we ask trainees to actually do research in trainings.

…doing research mostly involves making choices, and that every choice you make, you lose something and you gain something.

Nick: I think it’s partly that with most things the way to learn about it is trying to do it yourself. So even if what we ultimately want is for clinicians to be research literate, having the experience of conducting a piece of research is a great way to become more literate. For instance, a lot of our trainees assume that research is all about scientific truth. They often say “Are you allowed to do this?” and they are amazed to realise that doing research mostly involves making choices, and that every choice you make, you lose something and you gain something. And that the findings of research are always provisional, there are always limitations. I think even that demystification of research is really important, even if people never do research after the training, because they will be in an environment where research is informing practice, and where they need to be able to engage with it, learn from it and respond to it.

Isabel: Yes, it’s interesting that paradoxically doing research helps to debunk this idea of scientific expertise. Actually, that could be a very useful thing for a practitioner too, just in case in our practice, we might also wish to take up an expert position. So this idea of ‘science’ can find its way into practitioners’ practice… it’s quite a paradox in a way.

Nick: I agree. It’s interesting, I think there is an idea in some places, that during training, because we are learning something, that it is not helpful to have too much questioning. Some people have said that the problem with trying to be a researcher while you are training is that you are questioning things before you have fully identified with a position.

Isabel: Until you’ve got the ground from which to ask a question? It becomes all question and no knowledge?

Nick: So quite concretely if we read a paper, like an outcome study that questions whether child psychotherapy is the right approach for working with children in a certain context, some people would say that this will introduce doubts, at a time we are wanting trainees to develop confidence in the approach. And we do know from research that one of the things that affects practice is being confident in the approach you are working with. But I guess I feel that confidence doesn’t have to depend on being blinkered and refusing to question. I suppose I do fundamentally believe that we are more confident if we can take on board challenges and doubts rather than if we have blind certainty.

Isabel: It’s a different model of confidence.

Nick: It’s never a bad thing to stop and think “actually is that the right way to do it?”

Isabel: Have you got anything else that you think is important in terms of the place of research in child psychotherapy training, and what challenges there still are, despite this integration that you are attempting?

Nick: I think it’s a challenge that most of the people who are the trainers have had no research training themselves, so how do you model your trainees the value of this integrated approach, when most of the teaching staff don’t have that approach, and in some cases, are actively hostile. I think it’s a challenge to ask people to do research but the profession says you don’t need to do this to be a child psychotherapist, partly what message that gives, but also practically because it’s not a required part, but lots of other things are, so you are fitting lots of things on top of it.

Isabel: I imagine that a lot of people, perhaps not unlike counselling psychology, when they go into training, their wish is to become clinicians, that research is not the main wish. And similarly, when they finish, most child psychotherapists don’t carry on with research past their doctoral research?

Nick: To the best of my knowledge there are only two child psychotherapists in the whole of the UK with academic posts.

Isabel: That’s you and

Nick: [laughs] Me and one other person.

Isabel: Well it’s a start!

Nick: There are others with affiliations to universities but not academic posts. That’s a challenge that some of the trainees get really interested in research but there aren’t that many opportunities to take things further.

Isabel: Unless they go into academia and become trainers themselves.

Nick: They can certainly get involved in training, but in terms of going into academia, since there aren’t departments of child psychotherapy, there is no department to join. If you are trainer, you are not in a university, you go and teach your seminar. You would probably need to go on and do a PhD and then get an academic post but happen to be a child psychotherapist.

Isabel: So they really are separate careers in some ways, still.

Nick: My hope would be not that the doctoral training will necessarily help everyone to become researchers, but it would be nice if a small number thought, “This is something I would like to take further” and there were opportunities to take it further. And there are some child psychotherapists who have won research grants – again a small number but it’s beginning to happen. And then for those people to become the trainers of the next generation. That would be the hope, and that would make a big difference to how trainees experience the training and help with modelling the integration we are trying to achieve. But yes, there are a lot of challenges.

© Isabel Henton

Dr Nick Midgley trained as a Child and Adolescent Psychotherapist at the Anna Freud National Centre for Children and Families, and is a Senior Lecturer at the Research Department of Clinical, Educational, and Health Psychology at University College London. He is Course Director for the MSc in Developmental Psychology and Clinical Practice and Academic Course Director for the PsychD in Child and Adolescent Psychotherapy. Nick is the co-director of the recently established Child Attachment and Psychological Therapies Research Unit (ChAPTRe), an Anna Freud / UCL collaboration. He was the recipient of the British Psychoanalytic Council’s Early Career Award in 2010 and the Early Career Achievement Award from the Society for Psychotherapy Research in 2013.

Dr Isabel Henton is a Chartered Counselling Psychologist, an Associate of London Counselling Psychologists and a Senior Lecturer at Regent’s University.

 

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