Nicola Gazzola

From single-case studies to practice-based knowledge: Aggregating and synthesizing case studies

Abstract Recent developments in case study methodology reflect a rising interest that clinicians and researchers share in building a clinically useful and empirically sound knowledge base from single-case studies. The present article describes three types of single-case studies (clinical, experimental, systematic) and examines their potential contributions to psychotherapy research. It then lays out three ways in which single-case studies can be aggregated and synthesized to enhance clinical understanding: (a) a case database that allows clinicians to efficiently search for relevant cases, (b) a metasynthesis of single-case studies that integrates common themes across similar cases, and (c) an individual case comparison method in which closely matched cases are compared to identify both therapeutic and hindering processes.

What are the sources of feelings of incompetence in experienced therapists

Therapists’ subjective encounters with feelings of incompetence were explored to identify the origins of such experiences. Eight seasoned therapists were interviewed for approximately 90 minutes. The resulting transcripts were analyzed with a grounded theory approach. Therapist feelings of incompetence stemmed from four main sources: (a) permissible issues, (b) professional issues, (c) process issues, and (d) personal issues. Each of these categories, and the subcategories, are discussed in detail. Implications for therapist self-care as well as counsellor education are discussed.

Feelings of inadequacy, insecurity, and incompetence among experienced therapists

Feelings of incompetence are an ongoing part of the private experience of being a therapist. They are often linked to therapist stress, distress, and to negative therapeutic processes and outcomes, yet systematic inquiries into the subjective judgment of experienced therapists as inadequate and incompetent in their professional roles are rare. A qualitative approach was used in this study to obtain rich descriptions of encounters with feelings of incompetence among experienced therapists. Eight therapists with a minimum of ten years experience were recruited for the study and were interviewed using a semi-structured interview protocol. The resulting transcripts were analysed with procedures based on grounded theory methodology. Findings indicated that feelings of incompetence existed on a continuum of intensity and that the experience was multiply determined. Implications for therapist training and practice are presented.

Learning to Be Supervisors: A Qualitative Investigation of Difficulties Experienced by Supervisors-in-Training

This study examined the challenges and difficulties of supervisors-in-training during the course of providing individual and group supervision to masters-level counseling trainees using both group and individual formats. We interviewed 10 supervisors-in-training regarding their supervisory experiences with masters-level counselor trainees. Data analysis used a variation of the consensual qualitative research method (Hill, Thompson, & Nutt-Williams, 1997). The results included five categories of difficulties: (1) managing the “gatekeeping” role, (2) simultaneously managing multiple processes, (3) experiencing an ongoing attempt at establishing a supervisory stance, (4) self-doubt about their abilities as supervisors, and (5) managing dynamics with their co-supervisors. We discuss some reasons for the training difficulties that the doctoral supervisors-in-training experienced in assuming a new role and offer implications for supervision curricula and training in doctoral programs.

Super- (and not-so-super-) vision of counsellors-in-training: Supervisee perspectives on broadening and narrowing processes

ABSTRACT This study investigated the experiences of broadening and narrowing in the supervisory process from the perspective of supervisees. Ten supervisees who had completed all requirements for a masters degree in counselling were interviewed using a semi-structured interview. Data were analyzed using a consensual qualitative research method. Results included categories of supervisor and supervisee actions that contributed to both broadening and narrowing experiences in supervision. The results are discussed in light of implications for the process of supervision.

Professional identity among counselling psychology doctoral students: A qualitative investigation

Counselling psychology has always had an interest in exploring its professional identity. This may be due to diverse multidisciplinary influences on counselling psychology. While diversity and multiplicity can be considered a hallmark feature of the profession, it can also be a source of stress for doctoral students. This study explores counselling psychology doctoral students’ perceptions of their professional identities. It is guided by two research questions: (a) What experiences and conditions do counselling psychology doctoral students perceive as contributing to their professional identities? (b) What experiences and conditions do counselling psychology doctoral students perceive as hindering their professional identity? We developed a semi-structured interview protocol and interviewed 10 graduate students who had completed their first year of doctoral study. A variation of the consensual qualitative research method was used for data analysis. Seven categories of experiences that fostered professional identity and four categories of experiences that hindered professional identity were identified. These findings have implications for the practice of counselling psychology within the larger mental health delivery system as well as for the training of counselling psychologists, including counselling curriculum and counselling supervision.

A qualitative study of client experiences of working with novice counsellors

Aims: This paper reports on a qualitative analysis of written accounts by clients who participated in a counselling relationship with beginning-level trainees. The purpose of the study was to explore how clients experience the process of counselling with novice practitioners. Method: Consensual qualitative research was used for data analysis. Findings: Three general thematic categories were identified – client perceptions of self in counselling; client perceptions of the counsellor; and client perception of the counselling process. Conclusions: Overall, the findings suggest that these clients saw the interpersonal qualities and skills of the counsellor as major contributors to their experience. Implications: Clinical training of novices should start by developing the interpersonal and collaborative skills of trainees.

Counsellor interpretations and the occurrence of in-session client change moments in non-dynamic psychotherapies

This study explored the relationship between therapist interpretations and optimal in-session client processes in 20 sessions conducted by exemplary psychotherapists of three different theoretical orientations: Client-Centred Therapy (CCT), Rational-Emotive Behaviour Therapy (REBT), and Gestalt/Existential Therapy (GT). The results indicated that interpretations were used with similar frequency across therapeutic approaches, but they were neither superior nor inferior to other interventions in relation to the occurrence of optimal in-session client processes. The results support the notion that interpretation is a commonly used therapist intervention and that different therapies accentuate different aspects of interpretation. Implications for psychotherapy integration are offered and the findings are discussed with reference to theory and clinical practice.

Therapist Interpretations and Client Processes in Three Therapeutic Modalities: Implications for Psychotherapy Integration

This research investigated therapist interpretations and subsequent client actions in 3 therapeutic modalities—client-centered therapy, gestalt/existential therapies, and rational–emotive behavior therapy—by employing the coding system of the consensual qualitative research method (C. E. Hill, B. J. Thompson, & N. E. Williams, 1997). By allowing conceptual categories to emerge from these qualitatively analyzed data, the authors found that each approach had its own specific pattern of interpretation content as well as style of delivering the interpretations. Client reactions to interpretations were mostly positive. The results suggest that interpretation is a common therapeutic element and that different therapies nonetheless accentuate different aspects of interpretation. Implications for psychotherapy integration are offered, and the findings are discussed with reference to theory and clinical practice. The common factors perspective searches for fundamental similarities across therapies (Arkowitz, 1997) and suggests that the effectiveness of psychotherapy is contingent on factors other than theoretical orientation (Ahn & Wampold, 2001; Hubble, Duncan, & Miller, 1999). Although stud

Positive experiences of doctoral-level supervisors-in-training conducting group-format supervision: a qualitative investigation

Experiential learning opportunities are powerful in shaping positive supervisor behaviours. We were interested in examining the positive experiences of supervisors-in-training during their first practice experience as supervisors. Our study was guided by two research questions: (a) what are the experiences that supervisors-in-training viewed as positive during the course of providing clinical supervision to masters-level counselling trainees? and (b) how did these positive experiences contribute to their professional development? We employed a variation of the consensual qualitative research method developed by Hill, Thompson, and Nutt-Williams (1997) and interviewed 10 supervisors-in-training regarding their positive experiences in supervising masters-level counselling trainees. The results included five major categories of positive experiences: (a) the positive value of feedback; (b) enhanced confidence in using a wider variety of supervision tasks and procedures; (c) the impact of the experience on other aspects of professional practice; (d) increased familiarity with the multiple roles of the supervisor; and (e) for some, increased comfort navigating co-supervision dynamics. Each of these categories included subcategories. We discuss our findings within the context of supervision training in graduate education.