Practice-based research and counselling psychology: A critical review and proposal

Abstract

Content and Focus
This narrative literature review critically considers the relationship between practice-based research and counselling psychology. Its starting-point is contexts where gaps between psychotherapy research and practice have been identified. Developments in practice-based research, and the extent to which counselling psychology appears engaged in these, are then explored. Contexts in which practice-based research is conducted are considered, with particular focus on the practice-research network. The challenges associated with practice-research networks, in particular, the issue of practitioner involvement, are highlighted. These issues, relating both to counselling psychology’s engagement in practice-based research, and practitioners’ engagement in practice-research networks, suggest an exploration of the role of practitioner research training. Empirical literature relating to current counselling psychology research training programmes is reviewed. Recently, in the US and in Europe, a model of ‘practice-based research training’ has emerged as the next generation of practice-research network. Practice-based research training, as its name implies, involves the close integration of the activities of clinical practice, research and training. Examples of practice-based research training initiatives are outlined.

Conclusion
This paper aims to highlight the importance and relevance of practice-based research to counselling psychology in the UK and beyond. Practice-based research training is proposed as a highly promising paradigm for counselling psychology, with potential to ameliorate the gaps, deficits and challenges reported in this review.

Full text

Counselling Psychology Review, Vol. 27, No. 3, September 2012 11
© The British Psychological Society – ISSN 0269-6975
Introduction: Gaps between research
and practice
Outcome research versus clinical practice
IT IS UNSURPRISING, given the com-
plexity of psychotherapy, that no one
theory, methodology, or epistemology can
provide a comprehensive view of the thera-
peutic exchange (Castonguay, 2011).
However, perhaps more surprising is that
psychotherapy research and practice are
often described as opposing domains. For
example, in a word-association experiment,
clinicians described research as ‘objective,
hard, cold, scientific, factual, time-
consuming, difficult, prestigious, tedious,
expert’, whereas practice was seen as ‘subjec-
tive, busy, messy, difficult, soft, warm, pres-
sured, flexible’ (Darlington & Scott, 2002,
p.5).
In some contexts, relations between
psychotherapy research and practice can
sometimes even seem hostile. One such
context is experimental outcome research, in
the form of the Randomised Controlled Trial
(RCT), which clinicians have often suggested
is an inappropriate way to measure or eval-
uate psychotherapy. As Freud wrote to Saul
Rosenzweig in 1934, ‘I have examined your
experimental studies…with interest. I cannot
put much value on such confirmation
because the abundance of reliable observa-
tions on which these propositions rest makes
them independent of experimental verifica-
tion. Still, it can do no harm’ (cited in Talley,
Strupp & Butler, 1994, p.3).
Since Freud’s early pronouncement,
experimental research has been defended as
the only valid way to test causality, or the
Content and Focus: This narrative literature review critically considers the relationship between practice-
based research and counselling psychology. Its starting-point is contexts where gaps between psychotherapy
research and practice have been identified. Developments in practice-based research, and the extent to which
counselling psychology appears engaged in these, are then explored. Contexts in which practice-based research
is conducted are considered, with particular focus on the practice-research network. The challenges associated
with practice-research networks, in particular, the issue of practitioner involvement, are highlighted. These
issues, relating both to counselling psychology’s engagement in practice-based research, and practitioners’
engagement in practice-research networks, suggest an exploration of the role of practitioner research training.
Empirical literature relating to current counselling psychology research training programmes is reviewed.
Recently, in the US and in Europe, a model of ‘practice-based research training’ has emerged as the next
generation of practice-research network. Practice-based research training, as its name implies, involves the close
integration of the activities of clinical practice, research and training. Examples of practice-based research
training initiatives are outlined.
Conclusion: This paper aims to highlight the importance and relevance of practice-based research to
counselling psychology in the UK and beyond. Practice-based research training is proposed as a highly
promising paradigm for counselling psychology, with potential to ameliorate the gaps, deficits and challenges
reported in this review.
Keywords: Practice-based research; evidence-based practice; counselling psychology; research training;
psychotherapy research; practice-research network.
Trainee Prize Award Winner
Practice-based research and counselling
psychology: A critical review and proposal
Isabel Henton

12 Counselling Psychology Review, Vol. 27, No. 3, September 2012
‘efficacy’ of particular treatments (e.g.
Bower & King, 2000; Kihlstrom, 2006;
Fonagy, 2009). However, critics suggest
experimental science is epistemologically
incompatible with the artful, invisible, even
unconscious, ontologies of practice
(Holmes, 2002; Rustin, 2003), the ‘swampy
lowlands’ (Darlington & Scott, p.1) where
tacit knowledge operates to a great extent
(Thornton, 2006).
In particular, it is suggested, RCTs are
based on the incorrect assumption that
therapy acts on people, like drugs act on
medical symptoms (Elkins, 2009; Marzillier,
2004; Mollon, 2009; Stiles & Shapiro, 1989).
Moreover, the way RCTs are frequently
designed means their findings, whilst inter-
nally valid, cannot be generalised to real-
world clinical practice (Henton & Midgley,
2012; Seligman, 1995; Westen, 2006). For
instance:
1. RCTs generally rely on the Diagnostic and
Statistical Manual of Mental Disorders
diagnoses, but most clients do not fit these
criteria (Westen, Thompson-Brenner &
Novotny, 2004);
2. In RCTs, outcomes often equate with
symptom reduction, but outcomes (e.g. in
psychodynamic therapies) may require
broader definition (Wallerstein, 2003);
3. RCTs attempt to deliver pure treatment
orientations, but real practice is mostly
theoretically impure, and more likely
effective due to common factors (Frank &
Frank, 1991), such as the therapeutic
relationship (Norcross & Wampold,
2011), generic change principles (Beutler
& Castonguay, 2005), or therapist/client
characteristics (Mozdzierz, Peluso &
Lisiecki, 2009; Crits-Christoph & Gallop,
2006; Bohart, 2006);
4. RCT treatments are based on therapy
manuals, however, manual adherence may
limit clinical flexibility and lead to poorer
outcomes (Duncan & Miller, 2006); and
5. Principal Investigators’ allegiances usually
strongly predict RCT outcomes (Luborsky
et al., 1999).
As the last point implies, the debate is not
merely epistemological, but involves issues of
politics and economics (Elliott, 1998; Henry,
1998). The fact that RCT evidence is the
gold standard in the evidence hierarchy
dominating health services policy, commis-
sioning and insurance on both sides of the
Atlantic, has been heavily criticised (e.g. Guy
et al., 2012; Holmes et al., 2006). RCT find-
ings are the key influence on the UK
National Institute for Health and Clinical
Excellence’s (NICE) clinical guidelines
(Pilling, 2008), and the Improving Access for
Psychological Therapies (IAPT) programme
(UK Department of Health, 2010), and in
the US, on empirically supported treatments
(ESTs; Chambless et al., 1998, 1996; Chamb-
less & Ollendick, 2001). These political
developments have increasingly disenfran-
chised therapies less well represented in
RCT research (Bohart, O’Hara & Leitner,
1998; Wachtel, 2010), and arguably encour-
aged a ‘cookbook’ approach to therapy
(Parry, 2000).
Last year, a heated debate broke out in
the UK’s Therapy Today magazine involving
among others Counselling Psychologist Mick
Cooper (Cooper, 2011) and Richard House
(Rogers, Maidman & House, 2011). Rogers,
Maidman and House suggested that
psychotherapists should reject RCTs on the
basis of incompatible values. Cooper argued
therapists within orientations under-repre-
sented by RCTs should urgently consider
engagement, to ensure their professional
survival, particularly within the UK National
Health Service (NHS). In November 2011,
there was a similarly heated discussion at the
UK New Savoy (IAPT) conference, between
the Panel Chair, Michael Rawlins, Chairman
of NICE, and the floor. In his much-publi-
cised Harveian oration (an annual invita-
tional lecture held at the Royal College of
Physicians in London), Rawlins (2008)
seemed to have argued against the evidence
hierarchy, suggesting practitioners must be
‘teleoanalysts’, that is, they must evaluate
plural forms of evidence (Green & Glasgow,
2006). However, following the 2011 confer-
Isabel Henton

Counselling Psychology Review, Vol. 27, No. 3, September 2012 13
ence, and this author’s closer reading of
Rawlins’ oration, perhaps Rawlins was not
arguing against evidence hierarchies per se,
but simply suggesting hierarchies should not
be a substitute for clinical judgement. But
given the wider political forces potentially
impacting professional survival, this is
perhaps neither here nor there.
Overall, in these contexts, the research-
practice ‘gap’ feels something of a
misnomer: ‘Calling it a gap is like saying
there is an Israeli-Arab gap in the Middle
East. It is a war, involving deeply held beliefs,
political passions, views of human nature
and the nature of knowledge, and – as all
wars ultimately involve – money, territory
and livelihoods’ (Tavris, 2003, p.xiv).
Evidence-based practices versus evidence-based
practice
Evidence-based practice (EBP) is an impor-
tant, relevant paradigm here, and is a term
used in various ways (Ollson, 2007; Midgley,
2009). Sometimes it is short-hand for
evidence-based practices (EBPs plural), that
is, ESTs and parallel UK developments (e.g.
NICE guidelines; Roth & Fonagy, 2005).
However, the term EBP was originally coined
around the millennium from the term
‘evidence-based medicine,’ the latter
defined in the British Medical Journal as an
(ideal) form of clinical decision-making that
applies best research evidence and clinical
expertise to particular client needs
(Reynolds, 2000; Sackett et al., 1996).
Indeed, the American Psychological Associa-
tion (APA)’s ‘Evidence-Based Practice for
Psychology’ manifesto (2006) is holistic,
particularly emphasising the importance of
clinical judgment.
It has been suggested this latter meaning
of EBP (i.e. good clinical decision-making)
is based on a ‘practitioner-as-research-
consumer’ model (Elliott & Zucconi, 2006,
p.83), which can be constructed very differ-
ently from practitioner, outcome researcher
or policy-maker vantage-points. For instance,
practitioner-sympathetic commentators have
criticised academic researchers for their
‘empirical imperialism’ (Castonguay &
Borkovec, 2005, p.1): researchers expect
clinicians to ‘buy’ their research, regardless
of its presentation or relevance (Goldfield &
Wolfe, 1998; Persons & Silberschatz, 1998).
Moreover, seminal practitioner-sympathetic
survey research suggested that clinical expe-
rience, theoretical literature and pure
research were more useful to clinicians than
outcome research (Morrow-Bradley &
Elliott, 1986). Decades of further surveys
have, since the EBP paradigm, produced
increasingly nuanced and diverse findings
(Boisvert & Faust, 2006; Cook, Biyanova &
Coyne, 2009; Cook et al., 2009; Lucock, Hall
& Noble, 2006; Nelson & Steele, 2008;
Stewart & Chambless, 2007; Safran et al.,
2011). For example, in Cook, Schnurr et al.’s
2009 survey of 2500+ US psychotherapists of
different orientations’ 10 books most useful
to practice, although a Carl Rogers’ volume
came top, three books referenced ESTs, and
two were treatment manuals.
On the other hand, researchers have
strongly criticised therapists for insufficiently
consuming (reading/using) outcome
research (e.g. Williams & Irving, 1999), and
for not understanding the rationale for
outcome research designs (Persons & Silber-
schatz, 1998). More recently, from a top-
down policy perspective, an alternative
practitioner-as-research-consumer discourse
has emerged, which does at times seem
somewhat ‘imperial’ in tone. Within this
discourse, researchers/policy-makers adopt
dissemination or implementation science to
explore the ‘transportability’ (Gotham,
2006, p.610) of EBPs into clinical practice
(NICE, 2007; Parry, Cape & Pilling, 2003;
Proctor, 2004; Shafran, 2011; Stirman, Crits-
Christoph & DeRubeis, 2004). In this
context, EBP’s two meanings start to become
blurred, since dissemination research is
often about EBPs by proponents of estab-
lished EBPs, but is often justified on the basis
that EBP decision-making models are not
always elaborated in clear practical terms
(Dowie, 1996; Tanenbaum, 2003).
Practice-based research and counselling psychology: A critical review and proposal

14 Counselling Psychology Review, Vol. 27, No. 3, September 2012
Practice-based research
This review critically explores developments
within the alternative psychotherapy research
paradigm of practice-based research, and the
extent to which counselling psychology is
engaged with these developments. Practice-
based research (PBR) refers variously and
broadly to non-experimental research,
research by practitioners, research in natura-
listic/routine clinical settings, and particular
therapy research paradigms such as case-
studies, process research and effectiveness
studies. Proponents argue that, together with
experimental research, PBR provides a
comprehensive picture of psychotherapy,
and, therefore, PBR is of great value to clini-
cians, commissioners, and policy-makers
(Barkham et al., 2010a). It is also suggested
that in PBR, research and practice come
closer together than in other forms of
research such as outcome research (McLeod,
2001), and that this too is valuable to the same
communities (Castonguay, 2011). A brief
overview of the main forms of PBR follows.
Case studies
There are various systematic case study
protocols, involving diverse data-types, data-
gathering techniques, epistemologies, and
aims. However, most protocols involve
building a rich case-record of therapeutic
outcome and alliance measures, and qualita-
tive process notes/recordings, to form the
basis of a research report (McLeod &
Cooper, 2011). Case-studies might aim to
address outcome questions directly
(McLeod, 2000), to build/test theories
(Stiles, 2010) or more phenomenologically,
to describe experience (Flyvbjerg, 2006).
One influential protocol is the Hermeneutic
Single Case Study Design (HSCED; Elliott,
2002), in which a team attempts legalistically
to identify the causes of therapeutic change
by systematically eliminating other potential
intra-/extra-therapeutic explanations.
Process research
Process research is generally situated within
the therapy ‘events paradigm,’ the latter orig-
inating in Carl Rogers’ person-centred
approach to research (O’Leary, 2006). Early
process research aimed purely to identify
particular processes or events during therapy.
For example, task analysis (Greenberg, 1984)
uses detailed descriptions of tape-recorded
events to identify successful/unsuccessful
resolutions of therapeutic problems. Subse-
quently, process research began to explore
correlations between therapist/client pro-
cesses and outcome (Hill, 2006). The first
example of this approach was change process
research (CPR; Greenberg, 1986; Rice &
Greenberg, 1984), which uses sequential
analytic methods to identify specific speech-
acts, episodes, and relationships leading to
immediate, intermediate and final outcomes.
Other process research methodologies
(Timulák, 2010) include assimilation analysis
(Honos-Webb et al., 1998); comprehensive
process analysis (CPA; Elliott, 1989); consen-
sual qualitative analysis (CQA; Hill et al.,
2005; Hill, Thomson & Williams, 1997);
helpful and hindering events research
(Llewelyn et al., 1988); relational depth expe-
rience research (Wiggins, Elliott & Cooper,
2012); and moments of empowerment
research (Timulák & Lietaer, 2001).
Effectiveness research (practice-based evidence)
Effectiveness research is a form of outcome
research defined in contrast to efficacy
(experimental outcome) research by its
being conducted in naturalistic settings
(Lambert & Ogles, 2004; Nathan, Stuart &
Dolan, 2003; Seligman, 1995). Compared to
the PBR methods above, effectiveness
research has greater potential to go beyond
the correlational (Borkovec & Castonguay,
2006). In the UK, although effectiveness
studies tend to exclude experimental
controls (designed to increase internal
validity and thereby, the potential for causal
inferences), nevertheless these studies’ large
sample-sizes mean that smaller effects (e.g.
rare/adverse outcomes) can achieve statis-
tical significance, potentially providing
causal information (Parry et al., 2010).
Indeed, with higher statistical power, these
Isabel Henton

Counselling Psychology Review, Vol. 27, No. 3, September 2012 15
studies address questions RCTs may not, for
example, cost-effectiveness, the impact of
moderator variables (case-mix, treatment
length, therapist/patient factors), and
service/organisational factors. In the US,
effectiveness studies often do incorporate
experimental protocols such as randomisa-
tion and manuals by maximising internal
validity, such studies can potentially identify
causal relationships (Cahill, Barkham &
Stiles, 2010).
Since receiving a mandate from the
Department of Health’s strategic review of
psychotherapy services (1999), UK effective-
ness research has mainly been conducted in
NHS settings, supported by Clinical
Psychology university departments or
practice-research networks (Cahill et al.,
2010). More recently, the IAPT programme
has made large NHS data-sets available (e.g.
Glover, Webb, & Evison, 2010). Effectiveness
research is also conducted in UK voluntary
settings (e.g. Gardiner et al., 2003). UK
authors emphasise the complementarity
between effectiveness research – or Practice-
Based Evidence, as it is known in the UK
(PBE; Barkham & Mellor-Clark, 2000) – and
efficacy research, and how together these
forms of evidence are both rigorous and
relevant (Barkham et al., 2010a; Barkham &
Mellor-Clark, 2000). This emphasis seems to
reflect an apparently relatively top-down
political agenda in the UK towards democra-
tising psychotherapy research policy.
Barkham et al. (2010a) propose a cyclical or
dimensional relationship between efficacy
and effectiveness studies, citing research
showing that effect sizes of more and less
clinically representative studies are not
significantly different (Shadish et al., 1997).
Counselling psychology and practice-
based research
Mutuality and dialogue
With its postmodern emphasis (Chwalisz,
2003; Loewenthal, 2006; House, 2003;
Neimeyer & Diamond, 2001; Spinelli, 2001),
counselling psychology often emphasises the
différence between research and practice,
joining calls for mutuality and dialogue
between the two, rather than a closing of the
gap (Safran, 2001). For example, it is
proposed that ‘psychological science as a
human practice and psychological practice
as a human science’ should inform each
other (Hoshmand & Polkinghorne, 1992,
p.55). The dualistic science-practice distinc-
tion reflects the modernist professionalisa-
tion of knowledge and a positivistic view of
science (Chalmers, 1999). Counselling
psychology reframes both research science
and practice as discovery-oriented activities
of equal value (Hanley, 2010; Spinelli, 2001).
This mutual, equitable research-practice
relationship is elsewhere characterised as a
marriage both within counselling psychology
(BPS, 2006) and in the wider field. For
instance, Elliott and Morrow-Bradley (1994)
suggested that to save their troubled
marriage, research and practice should
engage in a more constructive dialogue.
These authors argue this is needed because,
as in a marriage, researchers and practi-
tioners depend on each other, like it or not,
for better or for worse. Certainly, research
needs practice: most major psychotherapy
research ideas are derived from practice
(Freud, Beck, Rogers). Since therapy
research is mostly applied, its ultimate aim is
presumably shared with practice, that is, to
alleviate human suffering (Castonguay,
2011). Conversely, practice needs research: it
has been argued that engaging in research
fosters conceptual clarity in practitioners by
making the implicit explicit, and that practi-
tioners need research (like jazz musicians
need systematic musical learning) to extem-
porise successfully (Safran & Muran, 1994).
At a broader level, research demystifies
practice, increasing accountability to
funders, and equity among consumers – for
practitioners to resist is arguably solipsistic,
even unethical (McLeod, 2001).
Pluralism
Counselling psychology discourse often
centres on methodological pluralism in
psychotherapy research, and the discipline
Practice-based research and counselling psychology: A critical review and proposal

16 Counselling Psychology Review, Vol. 27, No. 3, September 2012
has long advocated an expanded definition
of evidence to include less positivistic forms
(e.g. Howard, 1984). In the last decade,
counselling psychology has, alongside its
allied professions, repeatedly called for a
greater use of qualitative and mixed method-
ologies in psychotherapy research (Barbour,
2000; Haverkamp, Morrow & Pontoretto,
2005; McLeod, 2001; Midgley 2004; Rennie,
1994). A wide range of qualitative method-
ologies have been applied to psychotherapy,
including grounded theory (Rennie, 2006),
phenomenological methods (Wertz, 2005),
conversation analysis (Madill, Widdecombe
& Barkham, 2001), discourse analysis
(Spong, 2010), and narrative methodologies
(Etherington, 2009; Hoshmand, 2005).
Practice-based research
A brief scan of the UK’s Counselling Psychology
Review (CPR) in the last decade seems to
confirm counselling psychology’s research
philosophy parameters as postmodern,
pluralistic, qualitative, philosophical and
humanistic (Pontoretto, 2005). Most articles
seem to be small-scale explorations of
trainee or therapist experiences, or discus-
sions of professional or theoretical topics
(e.g. Martin, 2011; Walsh & Frankland, 2006,
2009; West, 2011). There seems to have been
relatively little practice-based research, that
is, case-studies, process research or effective-
ness research, in the CPR. This is curious,
given the profession’s statements about
marrying research and practice (BPS, 2006)
and the primacy of practice in generating
knowledge (Kasket & Gil-Rodriguez, 2011).
The situation may partly be due to the
lack of a UK ‘Journal of Counselling
Psychology’ (Hanley, 2011). However,
evidence from other sources also supports a
PBR gap in UK counselling psychology. For
example, apart from Michael Barkham (who
has a Counselling Psychology PhD), there
seem to be no UK counselling psychology
authors in a recent UK book about practice-
based evidence (Barkham, Hardy & Mellor-
Clark, 2010b). At the 2011 Society for
Psychotherapy Research (SPR) conference,
which hosted 680 psychotherapy research
presentations from 38 countries, there was
one poster, and four presentations from the
14 counselling psychology institutions in the
UK and Ireland. In a systematic review of
effectiveness studies (Cahill et al., 2010),
only 1/18 UK studies (again excepting
Michael Barkham) has a counselling
psychologist author, Terry Hanley (Gibbard
& Hanley, 2008). The recent suggestion that
to stem the EBP ‘juggernaut’, UK coun-
selling psychology should embrace pluralism
and social justice (Rafalin, 2010, p.45), seals
the impression that UK counselling psycho-
logy may be missing an opportunity to
include practice-based research among its
research priorities.
In the US, a scan of The Counseling
Psychologist (TCP)1and the Journal of Coun-
seling Psychology (JCP) suggests these journals
are more likely to publish pure research
relating to cultural issues than PBR. A special
edition of TCP (May 2011) confirms this
initial impression. Its key contribution,
‘Whatever happened to counselling in coun-
selling psychology?’ (Scheel et al., 2011a),
led to responses including ‘Declining coun-
seling research in counseling psychology
journals: Is the sky falling?’ (Lichtenberg,
2011), and (enigmatically) ‘The ghosts of
counseling psychology: Is counseling
research really dead?’ (Murdock, 2011).
Content analyses of TCP and the JCP showed
a decline in counseling-related research
from 77.7 per cent to 37.2 per cent on
average between 1979 and 2008 (Scheel et
al., 2011a). Meanwhile studies involving
attachment, multicultural and minority
issues, coping and well-being had grown in
frequency (Mallinckrodt, 2011). Of felt
concern to the profession’s academic status,
the small volume of counseling-related
research that did exist was the most-cited
in non-counseling psychology journals
(Lichtenberg, 2011). Although counseling is
Isabel Henton
1‘Counseling’ spelling used in US context.

Counselling Psychology Review, Vol. 27, No. 3, September 2012 17
what arguably defines counseling
psychology, and is most counseling psycholo-
gists’ main professional activity (Goodyear et
al., 2008), the fact this is no longer reflected
in its flagship journals ‘cannot be good news
for our identity’: counseling psychology
research is ‘a confusing pile of bricks’ rather
than a strong building or edifice (Scheel et
al., 2011b, p.687).
Practice-research networks
Overview
I would like to explore one context in which
PBR is conducted, the practice-research
network (PRN), where, again with some
exceptions, counselling psychology also
seems under-represented. PRNs are an infra-
structure or form of research action in which
practitioners and researchers collaborate to
co-construct research and build research
capacity as a form of social and intellectual
capital (Fenton et al., 2001). Most PRNs link
practitioners to funding and administrative
structures such as universities (Hickner,
1993). PRNs often involve pooling effective-
ness/outcome data from local services
collected using standardised measurement
sets. Subsequently high-quality regional,
national or even global databases can (if
desired) be built (Parry et al., 2010). PRN
data can thus inform practitioners, services
and policy-makers from micro- to macro-
levels (case-by case, practitioner-by-practi-
tioner, service-by-service) (Zarin et al.,
1997). PRNs are diverse, both in their aims
(pure research, clinical audit, bench-
marking, quality improvement), size, and
intended cover/reach (Parry et al., 2010;
Van Weel, 2002).
Within psychotherapy research, PRNs are
a recommended infrastructure (APA, 2006;
Borkovec & Castonguay, 2006; Parry et al.,
2010). Although most often associated with
practice-based and effectiveness research,
PRNs can be pluralistic, in theory also
conducting experimental and basic research
(Borkovec et al., 2001). Many psychotherapy
authors have argued that the value of PRNs
is their connection of research and practice
(Barlow, 1981; Goldfried & Wolfe, 1998;
Castonguay, 2011). Arguably, researcher alle-
giance and imperialism occurs in all
research (Bohart & House, 2008), but PRNs
have the potential to replace these forces
with research-practice democracy and
clinical relevance (Castonguay & Borkovec,
2005). In a health research context, this has
been described as moving from research as
enlightenment and research as retail, to
research as exchange (McDonald &
Viehbeck, 2007).
In the UK, one influential PRN is the
SPR-UK North PRN, established in 1995 by
Michael Barkham and colleagues, and
linked to Sheffield and Leeds Universities
(Barkham, Hardy & Shapiro, 2011). This
PRN has been heavily involved in the UK’s
PBE movement (Parry et al., 2010), and in
the development of the widely-used CORE
outcome measure (Gray & Mellor-Clark,
2007). In the US, one influential PRN is the
Penn State PRN, established in the late 1990s
alongside Pennsylvania State University’s
long-running clinical psychology psycho-
therapy research programme (Castonguay,
2011; Snyder, 1957). This PRN involves
Clinical Psychologist Tom Borkovec, Coun-
selling Psychologist Louis Castonguay, and
other influential US researchers in its
programmes.
Practitioner involvement
Aside from issues of resources (e.g. time and
energy involved; financial resources for
administration; assessment batteries and
data collection/management) and of design
(outcome choices, data collection processes,
data attrition) (Holloway, 1991; Levant,
2001; Norquist, 2001; Parry et al., 2010), one
significant issue for PRNs is practitioner
involvement. Practitioners involved in PRNs
are often enthusiastic unpaid volunteers, less
commonly they are recruited by service
managers, or randomly (Audin et al., 2001;
Norquist, 2001). However, PRNs vary in the
degree to which, and how, they aim to
involve practitioners, as well as their success
in doing so.
Practice-based research and counselling psychology: A critical review and proposal

18 Counselling Psychology Review, Vol. 27, No. 3, September 2012
Reasons for varying practitioner involve-
ment seem multifarious (Gard, 2003) and, as
elsewhere in this review, the issue of practi-
tioner involvement or engagement is appar-
ently subject to different discourses
depending on authors’ vantage-points. In the
UK, the emphasis (e.g. in the Sheffield/Leeds
PRN) seems more researcher- and policy-
driven. Within this more top-down discourse,
the focus seems to centre on how practitioner
non-representativeness can threaten the
validity of designs, about the effort involved in
creating a practitioner-friendly infrastructure,
and about how the lack of practitioner
research involvement may be one reason for
the relatively low research yield of UK PRNs to
date (Parry et al., 2010).
By contrast, the US Penn State PRN
seems to have a more bottom-up practitioner
or practitioner-researcher perspective. It is
argued that since everyone benefits from
more clinically-relevant research, the PRN’s
success is predicated on clinicians’ partici-
pating fully in designing and implementing
the research (Castonguay, 2011; Zwar et al.,
2006). Carl Rogers might have agreed since
he argued ‘the only hope of doing signifi-
cant research is to be immersed in clinical
work’ (Kirschenbaum & Henderson, 1989,
p.275). Castonguay, Boswell, et al. (2010a)
suggest PRN clinicians are the new scientist-
practitioners, and future studies must:
…intrinsically confound research with
practice…, [so that] it is impossible to
fully distinguish whether the nature of the
questions investigated, tasks imple-
mented, or the data collected are
empirical or clinical… It could be argued
that clinicians truly integrate science and
practice every time they perform a task in
their clinical practices and are not able to
provide an unambiguous answer to
questions such as: ‘Right now, am
I gathering clinical information or am
I collecting data?’ (pp.352–353)
Summary
Castonguay’s picture seems to be a prom-
ising challenge to doubts raised about the
viability of the scientist-practitioner model of
practice, for example, the suggestion that
researchers and practitioners are ‘different
kinds of people… with regard to abilities,
interests, cognitive styles… even the possi-
bility of differential cerebral dominance’
(Frank, 1984, p.429; cf. also Corrie &
Callahan, 2000; Midgley, 2004; Rogers et al.,
2011).
However, despite this promise, overall,
there are issues with practitioners’ degree of
engagement or willingness to engage in
PRNs, from whatever vantage-point, and
these issues may represent a stumbling-block
in PRNs’ ability to act as an infrastructure for
the production of PBR. Also, as stated at the
outset, counselling psychologists appear to
be less engaged in PRNs than allied profes-
sions are. For instance, although Michael
Barkham and Louis Castonguay are both
counselling psychologists, from my research
to date, there is no counselling psychology
PRN in the UK.
Following on from this, practice-based
research training (PBRT) has emerged as a
promising avenue that applies the PRN
concept to the psychotherapy/applied
psychology training setting. This develop-
mental model may have the potential ulti-
mately to increase the number of
clinician-researchers or PBR-initiating practi-
tioners entering qualified communities,
including counselling psychology (Heppner
et al., 1992). Before exploring what PBRT is
currently happening, it may be helpful to
review the current state-of-play within
existing counselling psychology research
training, to get a sense of whether there is
possible fertile ground in which to plant the
PBRT concept.
Counselling psychology research
training
Critical research engagement and knowledge
are professional and ethical requirements for
counselling psychologists according to the
UK Health Professions Council (HPC, 2009).
However, with doctoral qualification now the
mandatory gateway into counselling
Isabel Henton

Counselling Psychology Review, Vol. 27, No. 3, September 2012 19
psychology, research training may have
different meanings for its trainees than for
non-mandatory professional doctorate
trainees (e.g. in education/social care). The
latter trainees are arguably more likely to be
professionals with an existing ‘zeal’ to
increase their applied research knowledge
(Lee, 2009, p.1).
However, despite the fairly recent
doctoral mandate, empirical research
relating to counselling psychology research
training is historically rich and diverse. Some
salient literature is reviewed below.
Quantitative research
American counselling psychology researcher
Charles Gelso initiated an influential
programme of quantitative research when
he argued over 30 years’ ago that many
trainees begin their training feeling deeply
ambivalent towards research, an attitude that
the training environment does little to
improve, resulting in low research efficacy
and subsequent productivity or publication
output (Gelso, 1979). Gelso proposed nine
ingredients of an ideal ‘Research-Training
Environment’ (RTE; Gelso, 2006), six of
which have been empirically supported
subsequently. These are: (1) faculty model-
ling of appropriate research attitudes and
behaviour; (2) students’ research activities
are positively reinforced, formally and infor-
mally; (3) students are involved in research
early in training in a minimally threatening
way; (4) students are taught that all research
studies are limited; (5) trainings value and
teach varied research approaches; and (most
relevantly in this context); and (6) training
shows that research and practice can be
‘wedded’ (mutually enhancing/part of the
same construct system). Subsequent quanti-
tative research identified further RTE
factors, such as supportive mentors
(Hollingsworth & Fassinger, 2002) and
collaboration with peers (Love et al., 2007),
and suggested further interactions, for
example, between the RTE, personality and
gender (Mallinckrodt & Gelso, 2002).
Qualitative research
While this research is very interesting and
valuable, it tends to come from an academic
research perspective, with the top-down,
albeit important, objectives of increasing
research productivity and protecting profes-
sional status. The relatively small amount of
qualitative research in this area comple-
ments and extends these objectives, giving
voice to trainees’ attitudes and experiences,
and making further suggestions for research
training on the basis of its findings.
In a qualitative study of UK counselling
psychology trainees’ attitudes towards
research training, one course leader suggests
that most trainees enter the programme
wanting clinical rather than research careers
(Moran, 2011). Perhaps not surprisingly
then, many trainees express initially ambiva-
lent, but primarily negative feelings about
research, with fear of research and the sense
of research as ‘difficult’ ‘lonely’ and ‘frus-
trating’ predominating, although some later-
stage trainees have found research ‘exciting’
and ‘nourishing’ (p.174). Similarly, course-
leader Frank Piercy asked US family therapy
doctoral trainees to articulate their feelings
about research, using poems and metaphors
(Piercy et al., 2005). This produced particu-
larly rich data: as in Moran’s study, one
participant’s poem beautifully captures
trainees’ ambivalence about research, but
also research’s status as a gateway to clinical
practice: ‘Roses are red, violets are blue,
research is a thorn in my side, but it will help
my dreams come true’ (p.369).
Summary
In general, what quantitative research, quali-
tative research and commentary in this area
have in common is that they often start with
deficits within current research training
programmes or trainees’ negative/ambiva-
lent attitudes towards research, and end with
suggestions for how to improve research
training. These suggestions are usually
consistent with Gelso’s recommended RTE
(Gelso, 2006), for example, one frequent
proposal across the board equates to Gelso’s
Practice-based research and counselling psychology: A critical review and proposal

20 Counselling Psychology Review, Vol. 27, No. 3, September 2012
sixth criterion: to wed research and practice
more firmly together during training
(Moran, 2011; Piercy et al., 2005; Rowland &
Goss, 2000; Safran, 2001). This then is fertile
ground for considering the practice-based
research training phenomenon.
Practice-based research training2
Overview and examples
In the same spirit as PRNs’ confounding of
research and practice, practice-based
research training (PBRT) intentionally
fosters a ‘healthy confusion’ in trainees
between three normally discrete activities:
clinical practice, research and training
(Castonguay, 2011, p.135). PBRT is for
trainees, it is suggested, ‘not a bad way to get
addicted, from the get-go, to the scientific-
practitioner model’ with the potential to
‘create an intellectual and emotional (hope-
fully secure) attachment’ to this model
(Castonguay, 2011, p.135).
In the US, one PBRT is the Penn State
PRN in its third generation: a clinical
psychology training clinic that has been
transformed into a PRN, where trainees
simultaneously conduct clinical work and
practice-based research with community
clients (Borkovec, 2004; Castonguay et al.,
2004). As with the Penn State PRN involving
qualified practitioners, the clinic operates a
core assessment battery and standardised
assessment procedures, as well as a research
proposal selection committee involving
trainees.
A recent European initiative is the Inter-
national Project on the Effectiveness of
Psychotherapy and Psychotherapy Training
(IPEPPT; Elliott & Zucconi, 2006). Estab-
lished in Italy in 2004, the IPEPPT aims to
improve psychotherapy and psychotherapy
training by encouraging systematic practice-
based research in therapy training institutes
and university-based training clinics. The
IPEPPT steering committee is led by Robert
Elliott, Professor of Counselling at the
University of Strathclyde. Elliott has
suggested that socially constructed research-
practice gaps are more likely to be amelio-
rated ‘if we consciously try to build a reality
where from the first steps a more integrative,
bottom-up strategy is used’ (Elliott &
Zucconi, 2006, p.84).
Empirical research
Perhaps because PBRT is a relatively new
idea, we know little about it, and particularly,
we know little of trainees’ experiences of
involvement in PBRT, in other words, we
don’t have much of a ‘bottom-up’ ground-
level view. There are some first-person
accounts and questionnaire studies from
trainers involved in PBRT (e.g. McWey et al.,
2006; Sauer, 2006; Stinckens et al., 2009),
from which trainees’ perspectives on PBRT
are beginning to emerge. For instance,
McWey et al. (2006) highlight family therapy
students’ perceptions of the benefits of
PBRT (including a potential future research
career, research skills and confidence,
learning about research ‘messiness’, enjoy-
ment of creative group research processes)
and its challenges (increased time demands,
the ‘free-rider’ phenomenon, competitive-
ness, differing ability levels). Involvement in
PBRT challenged these students’ original
perceptions of research: for example, one
student commented ‘Hey, this is fun. Are you
sure this is research?’ (p.261).
In association with the IPEPPT, Leuven
University in Holland has integrated a
systematic research case-study protocol into
its postgraduate person-centred counselling
training programme (Stinckens, Elliott &
Leijssen, 2009). Stinckens et al.’s mixed-
methods questionnaire study of counselling
trainees’ attitudes the case study research
project also produced interesting data.
Trainees suggested research processes had
intensified or deepened the therapy they
delivered, increased their therapeutic sensi-
tivity and curiosity, illuminated aspects they
Isabel Henton
2‘Practice-Based Research Training’ (PBRT) is an umbrella term for ‘Training clinic PRNs,’ ‘Psychology Training
Clinics’ attempting research-practice integration, and ‘Practice-based therapy research in training sites’.

Counselling Psychology Review, Vol. 27, No. 3, September 2012 21
hadn’t noticed clinically (e.g. therapy
ruptures), and helpfully anchored the
therapy for both trainee therapist and client.
Summary and conclusion
This literature review has explored the rela-
tionship between practice and research,
including varying perspectives on outcome
research versus clinical practice, evidence-
based practice(s), practitioner-as-research-
consumer, practitioner involvement in
research, the practice-research networks,
and research training. It has focused particu-
larly on the degree of relationship between
counselling psychology and practice-based
research, proposing that engagement in PBR
is important and relevant to counselling
psychology’s identity and future professional
status. However, this relationship seems to be
less emphasised than it might be within the
zeitgeist of counselling psychology, where
frameworks such as postmodernism and
social justice are currently more central.
Practice-based research training (PBRT)
seems to be a highly promising integrative
research training paradigm. Perhaps it has
the potential, not only to bring research and
practice closer together in counselling
psychology research training programmes,
but also (ultimately) to increase PBR output
by qualified counselling psychologists. This
review aims to increase the circulation of the
PBRT concept within counselling psychology
in the UK. Additionally, in so far as PBR
output is important and relevant to our
profession, this potential chain of relation-
ships, beginning with PBRT, seems vitally
important to support via further empirical
research.
About the Author
Isabel Henton is a second-year counselling
psychology trainee at London Metropolitan
University. She hopes to carry out her
doctoral research on counselling psychology
trainees’ experiences of integrating practice
and research during training. Any comments
or ideas relating to this or any other matter
raised in this paper would be most welcome.
Correspondence
Email: isabelhenton@yahoo.co.uk
Practice-based research and counselling psychology: A critical review and proposal

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