As the incoming President of the Society for the Advancement of Psychotherapy, I am delighted by the opportunity to share with you some of the passion I have for psychotherapy, psychotherapy research, and psychotherapy training. As a professor of psychology, I have been lucky to be able to “do it all” and want to use this opportunity to hopefully inspire some of you to become as excited as I have been about this incredible field. Working together, we can help the field grow and prosper.
The first topic I want to tackle is qualitative methods in psychotherapy research. This topic is particularly salient right now because Sarah Knox and I were just the editors of an amazing series for APA on qualitative research methods. The series consists of 12 small, affordable, “how-to” books by senior, well-qualified researchers who write clearly and compellingly about qualitative methods that they have been thoroughly immersed in and love. The first 6 of these books are now available through the American Psychological Association, and the next 6 will be available this summer. The authors of these books will be giving webinars so that you can get a taste of each of the methods. You can order the books and sign up for the webinars at go.apa.org/qualitative-methods (site will be updated as the rest of the books and webinars become available).
Now, let me go back and tell you how I became interested in qualitative research and what it has to offer psychotherapy. I began my research career using quantitative methods, the only method available at the time. Over time, I became discouraged with these methods for doing psychotherapy process research (see Hill, 1984 for a description of my early process of becoming a process researcher). I spent a lot of time developing measures and training judges to code therapist skill, therapist intentions, client reactions, and client behaviors. The typical method was to have three judges independently code to high reliability a behavior from a therapy session using an established well, validated measure, and then use the code that 2 of the 3 agreed upon. The problem was that the demand for high interrater agreement/reliability was unrealistic. Few of the behaviors that occur in psychotherapy are clear-cut, but rather rely on context, manner, stage or treatment and a multitude of other variables. Clearly, trying to chunk therapist skills, for example, into 12 categories is absurd given the richness of variety of things therapists do. Forcing judges to try to think about how others might code something to force high interrater agreement/reliability was a poor use of the judges’ clinical intuition, but that is what our methods required as “good science” to find “truth” and get studies published.
Beginning in the 1980s, I started hearing rumblings about qualitative research. These methods at the time seemed unclear and “unscientific.” But meanwhile, I began exploring more discovery-oriented methods (Hill, 1990; Mahrer, 1988) where we developed measures based on the data and then trained judges to reliability in using them. It was a step away from traditional methods and emphasized an exploratory approach of learning from the data.
Robert Elliott and Bill Stiles, both process researchers, were very influential in helping me begin to accept and learn qualitative methods. Robert collaborated with Renee Rhodes, Barbara Thompson, and me on our first venture into qualitative methods in a neat study we did on misunderstandings in psychotherapy (Rhodes et al., 994). We discovered that the pathways differed for clients when the misunderstanding (rupture) was processed openly and therapists apologized and took responsibility for errors versus when clients “went underground” and did not express their feelings. In the latter cases, the misunderstanding persisted and therapy often terminated soon thereafter.
After a few more studies, we began to feel like we had a method that merged the best of the old process research (e.g., use of multiple judges, clear coding categories, sticking close to the data) with the newer qualitative methods (e.g., use of consensus rather than interrater agreement/reliability). We have been tinkering with this consensual qualitative research (CQR) method now for about 30 years, culminating in our most recent book (Hill & Knox, 2021). We’ve been able to use CQR to explore some exciting aspects of psychotherapy that were difficult to study using the older methods (e.g., therapist self-disclosure, immediacy, silence; client crying, internal representations).
It’s been great fun and liberating to move beyond the traditional methods and try new things. It’s also been challenging to convince the “establishment” that qualitative methods are indeed “science.” Being involved in qualitative research has also helped me challenge my assumptions about “truth” and rethink what we know and how we know it.
The new methods in this series open up even more possibilities in terms of qualitative research. I have learned a lot about new methods (autoethnography, conversation analysis, critical-constructivist grounded theory, critical participatory action research, descriptive-interpretive qualitative research, ideal-type analysis, discursive psychology, interpretative phenomenological analysis, interpretive phenomenological analysis, narrative analysis, and thematic analysis) and am excited to apply them in my own research.
My hope for the future is that we will discover many new and better ways to understand psychotherapy. We need methods that help us describe the complexity and beauty and individuality of the therapeutic endeavor. Psychotherapy truly is an art in search of a science.
Cite This Article
Hill, C.E. (2021). 2021 president’s column 56(1). Psychotherapy Bulletin, 56(1), 2-4.
Hill, C. E. (1984). A personal account of the process of becoming a counseling process researcher. The Counseling Psychologist, 12(3), 99-109. doi:10.1177/0011000084123010
Hill, C. E. (1990). A review of exploratory in-session process research. Journal of Consulting and Clinical Psychology, 58, 288-294. Review article; invited article. doi.org/10.1037/0022-006X.58.3.288
Hill, C. E., & Knox, S. (2021). Essentials of consensual qualitative research. Washington DC: American Psychological Association.
Mahrer, A. r. (1988). Discovery-oriented psychotherapy research: Rationale, aims, and methods. American Psychologist, 43(9), 694-702. https://doi.org/10.1037/0003-066X.43.9.694
Rhodes, R., Hill, C. E., Thompson, B. J., & Elliott, R. (1994). Client retrospective recall of resolved and unresolved misunderstanding events. Journal of Counseling Psychology, 41, 473-483. doi.org/10.1037/0022-0184.108.40.2063