Psychotherapists’ handling of sexual attraction to clients: A grounded theory

1. Psychotherapists’ handling of sexual attraction to clients: A grounded theory Anthony Arcuri – UNSW QHeRC Meeting 8 April 2008

2. Background • A poorly developed literature • RQ: What is the process of psychotherapists’ handling of sexual attraction to clients? • Method: Grounded theory • Generator of theory “where existing theory is inappropriate, too abstracted, or absent entirely” (Henwood & Pidgeon, 2003, p. 134).

3. What is a grounded theory? “Derived from data, systematically gathered and analyzed through the research process.” (Strauss and Corbin, 1998, p. 12). Aim “is to produce innovative theory that is ‘grounded’ in data collected from participants on the basis of the complexities of their lived experiences in a social context.” (Fassinger, 2005, p. 157).

4. The research process • Step 1: Articulate own conceptual framework • Clarify ‘sensitising concepts’. Helps: • Minimise / remain sensitive to bias (bracketing) • Self-reflection / reflexivity • Reader judgement • My sensitising concepts: • constructivist paradigm • training and practice as therapist • prior knowledge of literature • belief that SA acceptable

5. Step 2: Ethical considerations • ‘Trustworthiness’ (Haverkamp, 2005) • Ethics committee • Therefore, exploration of hypothetical,rather than actual, accounts of sexual attraction • Pros: less threatening, perhaps more trustworthy. • Cons: is a hypothetical account an adequate substitute for experience?? Will the data be less rich??

6. Step 3: Sampling Psychologists who practice psychotherapy Advertisement 36 responses – screened for suitability First participant recruited purposively Subsequent participants – theoretical sampling

7. Example of theoretical sampling Early concept: Self-disclosing sexual attraction to client Theorised to be influenced by the therapist’s theoretical orientation – participant said she might because of psychodynamic background So, sampled therapists with different theoretical orientations – CBT, systemic, narrative, mixed – to see if they would or wouldn’t based on their backgrounds.

8. Step 4: Interviews • 11 interviews in total • 6 men, 5 women • Mid-twenties to mid-sixties; 1-40 years’ experience • Range of theoretical orientations • Small number, as intended to represent an experience, not a population • Interview guide – ever-changing, based on emerging concepts, but open to new concepts • Interview process – talking about sex with a stranger in a closed room

9. Step 5: Data Analysis – Open and Axial Coding • Open coding – identifying concepts, and their properties and dimensions • Axial coding – relating concepts to each other on basis of their properties and dimensions • Using a ‘paradigm’ • Conditions  actions/interactions  consequences • Some grounded theorists opposed to this • My adapted paradigm: Conditions  considered actions/interactions  expected consequences  actual actions/interactions  actual consequences • Provisional hypotheses

10. Example of Axial Coding • Psychotherapists are likely to deem mutual, highlyintense sexual attraction to clients (characterised by preoccupation, anxiety and guilt) unmanageable, and thus decide to discontinuepsychotherapy with these clients to prevent negativeconsequences (loss of objectivity, sexual contact). • Categories highlighted in bold, their properties underlined, and their dimensions italicised

11. Data Analysis Cont’d – Coding for Process and Selective Coding • Coding for process – identifying sequences of action/interaction • Selective coding – integrating and refining theory • Theoretical saturation • Storyline • Diagrams • Sorting and reviewing of memos • Writing the grounded theory

12. Step 6: Reliability and Credibility Checks • Independent coding by supervisor • Internal consistency, completeness and logical progression • Credibility • Some participants commented on ‘storyline’

13. A grounded theory Awareness of options for handling the sexual attraction - Management of the sexual attraction - Therapeutic use of the sexual attraction - Guidance seeking - Privileging the sexual attraction - Discontinuation of psychotherapy Psychotherapist’s characteristics - Combined personal and professional identities - Maturational characteristics - Psychotherapy training history - Theoretical orientation - Relationship status - Gender Assessment of the consequences and ethicality of options for handling the sexual attraction Development of sexual attraction to a client - Client’s characteristics and behaviours - Psychotherapist’s characteristics - Process of the therapeutic relationship Phenomenon of sexual attraction to a client Appraisal of the sexual attraction - Intensity - Degree of interference with psychotherapy - Mutuality - Client’s characteristics - Timing - Reasons Decisions regarding the handling of the sexual attraction Perceived manageability of the sexual attraction Consequences of the implemented action - Cessation of psychotherapy - Continued therapy with incompletely or unsuccessfully managed sexual attraction - Continued psychotherapy with managed sexual attraction Implementation of the chosen action

14. Limitations • Me – style, bias • Hypothetical rather than actual accounts • Some poorly developed concepts due to above

15. Some highlights • First theory of its kind • First identification of: • Intensity as important component of the sexual attraction • Dilemmas involve in referral to other practitioners • Clear barriers and facilitators to guidance seeking

16. Discussion questions How does theorising differ from generalising? How should one handle highly sensitive or potentially illegal information disclosed in a face-to-face interview? How about in a focus group? How much of a grounded theory comes from data and how much from the researcher? What is an optimal balance that ensures the integrity of the research? How flexible are qualitative methods? Should one follow guidelines closely, or adapt methods to one’s own approach? Are hypothetical accounts of phenomena worth investigating?

17. References Fassinger, R. E. (2005). Paradigms, Praxis, Problems, and Promise: Grounded Theory in Counseling Psychology Research. Journal of Counseling Psychology, 52(2), 156-166. Haverkamp, B. E. (2005). Ethical perspectives on qualitative research in applied psychology. Journal of Counseling Psychology, 52(2), 146-155. Henwood, K., & Pidgeon, N. (2003). Grounded theory in psychological research. In P. M. Camic, J. E. Rhodes & L. Yardley (Eds.), Qualitative research in psychology: Expanding perspectives in methodology and design (pp. 135-155). Washington: American Psychological Association. Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks: Sage Publications, Inc.