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A Synthesis of the Reflective and Scientific Counselling Psychologist Practitioner: Dynamics in Research, Practice, and Clinical Supervision Portfolio for the Professional Doctorate in Counselling Psychology (DPsych) Alison E Walne City University Department of Psychology Submitted July 2015 1 THE FOLLOWING PARTS OF THIS THESIS HAVE BEEN REDACTED FOR DATA PROTECTION REASONS: pp 171-172: Appendix 4. Letter authorising research. pp 248-270: Section C: Case Study. The emotional effects of Anxiety: an Integrative Therapeutic approach. THE FOLLOWING PART OF THIS THESIS HAS BEEN REDACTED FOR COPYRIGHT REASONS: p247: Appendix 27: AMSTAR Criteria http://www.nccmt.ca/registry/view/eng/97.html Table of Contents Acknowledgements....................................................................................................8 City University Declaration......................................................................................9 PART A: PREFACE..............................................................................................................10 References.................................................................................................................14 PART B: THE RESEARCH.................................................................................................16 Abstract....................................................................................................................17 1. Chapter 1: Literature Review................................................................................18 1.1 Introduction...............................................................................................................18 1.2 The Therapeutic Relationship...................................................................................20 1.3 Conceptualisation of the Therapeutic Alliance.........................................................23 1.4 Therapeutic Alliance and Outcome...........................................................................24 1.5 Therapeutic Alliance Scales and Factors Currently Involved...................................29 1.6 Rating the Therapeutic Alliance................................................................................34 1.7 Therapist Characteristics and Relational Factors in the Therapeutic Alliance.........42 1.8 Evolution of the Therapeutic Alliance......................................................................45 1.9 Do We Need the Therapeutic Alliance and Therapeutic Alliance Measurement?...47 1.10 Summary of the Literature Review...........................................................................47 1.2.1 Rationale for the Study..............................................................................................49 1.2.2 Relevance to Counselling Psychology......................................................................54 1.2 3 Ethical Considerations..............................................................................................55 1.2.4 Reflexivity.................................................................................................................56 1.2.5 Personal Reflexivity..................................................................................................57 1.2.6 Epistemological Reflexivity......................................................................................59 1.3.1 Research Aims..........................................................................................................60 1.3.2 Research Objectives..................................................................................................60 1.3.3 Research Questions...................................................................................................60 1.3.4 Pilot Study.................................................................................................................60 2. Chapter 2: Methodology.........................................................................................61 2.1 Research Design........................................................................................................61 2.1.2 Phase One Overview: Focus Group..........................................................................61 2.1.3 Phase Two Overview: Panel Judges.........................................................................62 2.1.4 Phase Three Overview: Online Survey.....................................................................62 2.2 Participants................................................................................................................63 Demographics Focus Group (Table 1)......................................................................63 Demographics Panel Judges (Table 2)......................................................................64 2.2 1 Inclusion Criteria: Phase One and Two - Focus Group and Panel Judges................65 2 2.2.2 Exclusion Criteria: Phase One and Two - Focus Group and Panel Judges...............65 2.2.3 Inclusion Criteria: Phase Three - Online Survey......................................................65 2.2.4 Exclusion Criteria: Phase Three - Online Survey.....................................................65 2.2.5 Recruitment...............................................................................................................65 2.2.6 Sample Size...............................................................................................................66 2.2.7 Procedure...................................................................................................................66 2.2.8 Materials....................................................................................................................70 2.3 Data Analysis............................................................................................................71 2.3.1 Analysis Overview....................................................................................................71 2.3.2 Phase One: Rationale for a Focus Group Interview..................................................73 2.3.3 Phase One: Rationale for a Focus Group – Use of Two Measures...........................73 2.3.4 Phase One: Rationale for a Focus Group Manual Analysis .....................................74 2.3.5 Phase One: Rationale for a Focus Group Computer Qualitative Content Analysis..74 2.3.6 Phase One: Rationale for a Focus Group NVivo 10: Computer Coding Analysis...75 2.3.7 Phase One: Focus Group Transcript Analysis: Initial Statements............................75 2.3.8 Phase Two: Rationale for a Hybrid Thurstone-Likert Model...................................77 2.3.9 Phase Two: Rationale for Thurstone Scaling and Panel Judges...............................77 2.3.10 Phase Two: Thurstone Scaling: Analysis Process....................................................78 2.3.11 Phase Three-Part A: Rationale for Likert-Type Scaling: Online Survey Respondents..............................................................................................................79 2.3.12 Phase Three-Part A: Likert-Type Scaling: Analysis Process....................................79 2.3.13 Phase Three-Part B: Exploratory Factor Analysis: Analysis Process.......................79 3. C h a p t e r 3 : R e s u l t s .. . . . . . . . . . . . . .....................................................................................80 3.1 Results Overview.....................................................................................................80 3.1.1 Qualitative Content Analysis Focus Group Manual Coding.....................................81 3.1.2 What Is The Therapeutic Alliance?...........................................................................82 3.1.3 When Does The Therapeutic Alliance Start?............................................................83 3.1.4 How Do Therapists Develop The Therapeutic Alliance?.........................................83 3.1.5 How Do Therapists Maintain The Therapeutic Alliance?........................................84 3.1.6 Is The Therapeutic Alliance Measurable?.................................................................85 3.1.7 Qualitative Content Analysis – Focus Group: NVivo 10 Coding.............................86 3.1.8 Word Frequency Count Process: NVivo 10..............................................................88 3.2 Panel Judges..............................................................................................................89 3.3 Quantitative Results Overview..............................................................................92 3.3.1 Exploratory Factor Analysis Overview.....................................................................94 3.3.2 Descriptive Statistics.................................................................................................95 3.3.3 Exploratory Factor Analysis Results: Q1-22............................................................97 3.3.4 Varimax Orthogonal Rotation.................................................................................102 3.3.5 Direct Oblimin Rotation..........................................................................................106 3.3.6 Exploratory Factor Analysis Results: Q23-27........................................................109 3.3.7 Reliability................................................................................................................112 4. Chapter 4: Discussion...........................................................................................114 4.1 Study Overview.......................................................................................................114 4.2 Participant Demographics.......................................................................................116 3
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