Towards an Existential Phenomenological Family Therapy Model of Working with Issues of Alcohol ...

239 Pages·2017·1.72 MB·English

by  Andrew Biss

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Biss, Andrew (2017) Towards an existential phenomenological family therapy model of working
with issues of alcohol abuse: a grounded theory study. DProf thesis, Middlesex University.
[Thesis]
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Towards an Existential Phenomenological Family
Therapy Model of Working with Issues of Alcohol
Abuse: A Grounded Theory Study.

Submitted to the New School of Psychotherapy and Counselling and Middlesex
University in partial fulfilment of the requirements for the Degree of Doctor of
Existential Counselling and Psychotherapy.

Andrew Biss

2016, London, United Kingdom
DECLARATION

I hereby declare that the work presented in this thesis is written by myself entirely
except where other sources are clearly and identifiably cited.

Signed: ………………………………………….

Dated: ……………………………………………

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ABSTRACT

This research is a step towards creating an existential phenomenological model of
family therapy when working with alcohol abuse. The research method was
constructivist grounded theory and involved interviews with twelve experienced
family therapists. From an initial one hundred and twenty-five provisional categories
the data was analysed to form eight main concepts. Each of the concepts contains a
family therapy and an existential phenomenological perspective. The model can be
considered in three formats; a review of family therapy when addressing alcohol
problems, an existential phenomenological approach to that situation and an
integrated version. The model is described and shown in diagram form and can be
used by practitioners in part or whole to assist in their work with families.

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ACKNOWLEDGEMENTS

Conducting this research has been a significant challenge over the last three years
and I would not have achieved it without a lot of support from others. I would firstly
like to thank my two research supervisors, Professor Simon du Plock and Dr Chloe
Paidoussis Mitchell, whose guidance and support was invaluable. I would also like to
thank my clinical supervisor Martin Adams, for showing me the way to become an
existential psychotherapist. I owe a large debt of gratitude to the staff and fellow
students of the New School of Psychotherapy and Counselling who tolerated my
idiosyncrasies and inspired me to succeed.

I have made some new friends along the way and my thanks to Dr Ryan Kemp and
Professor Richard Velleman for sharing their insights with me. My research
participants took time away from their busy lives to speak to me and I will always be
grateful.

Finally, on a more personal note, I would like to thank my daughter Laura for the loan
of her Labrador Monty, who on long walks helped me to retain my sense of
proportion about life and my wife Pauline, who despite having no interest in
psychotherapy at all, still managed to support me in so many ways.

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TABLE OF CONTENT

1. Introduction ……………………………………………………. 9
1.1 Structure of the Thesis …………………………………………………… 9
1.2 Towards the Beginning …………………………………………………... 12
1.3 Aim of the Research ……………………………………………………… 14
2. Literature Review ……………………………………………... 20
2.1 Introduction ………………………………………………………………… 20
2.2 Addiction and Alcohol Abuse ……………………………………………. 22
2.2.1 Neurobiological Perspective …………………………………………… 29
2.2.2 The Diagnostic and Statistical Manual of Mental Disorders …......... 31
2.2.3 Alcoholics Anonymous …………………………………………………. 33
2.2.4 Cognitive Behavioural Therapy …………………………………......... 34
2.2.5 Counselling for Alcohol Problems ……………………………………. 35
2.3 Existential Psychotherapy and Addiction ……………………………… 39
2.3.1 The Problem Drinker and Self ………………………………………… 42
2.3.2 Addiction as a Social Construct ………………………………………. 44
2.3.3 Existential Phenomenological Therapy ………………………………. 47
2.4 Family Therapy and Existential Therapy ………………………………. 51
3. Research Methodology ……………………………………… 57
4. Choice of Research Methodology …………………………. 57
4.1 Introduction ………………………………………………………………. 57
4.2 Quantitative or Qualitative? ………………………………………………. 58
4.3 Epistemology ……………………………………………………………… 60
4.4 Phenomenological Consideration ………………………………………. 61
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4.5 Grounded Theory …………………………………………………………. 67
4.5.1 Constructivist Grounded Theory ………………………………………. 69
4.5.2 Constructivist Grounded Theory Methods …………………………… 71
4.5.2.1 Intensive Interviewing ………………………………………………… 71
4.5.2.2 Data Collection and Analysis ……………………………………....... 73
4.5.2.3 Grounded Theory Coding Practices ………………………………… 74
4.5.2.4 Memo Writing …………………………………………………………. 76
4.5.2.5 Developing Categories ………………………………………………. 77
4.5.2.6 Theoretical Sampling …………………………………………………. 78
4.5.2.7 Theoretical Sorting, Diagramming and Integrating ………………… 79
4.5.2.8 Interpretive Definition of Theory ……………………………………… 79
5. Pilot Study ……………………………………………………… 79
5.1 Introduction ………………………………………………………………. 79
5.2 Sampling and Recruitment ……………………………………………… 80
5.3 Ethics ………………………………………………………………………. 85
5.4 Data Collection and Analysis …………………………………………… 86
5.4.1 Procedure ………………………………………………………………. 87
5.4.2 Initial Coding ……………………………………………………………. 90
5.4.3 Focused Coding ………………………………………………………… 93
5.4.4 Axial Coding ……………………………………………………………. 97
5.4.5 Memo Writing ……………………………………………………………. 97
5.4.6 Reflexivity ………………………………………………………………… 101
5.4.7 Transition from Pilot Study ……………………………………………... 104
6. Study Results – Participants ………………………………… 106
6.1 Study Results – Conceptualization and Theory ………………………… 108
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6.2 Achieving Saturation or Theoretical Sufficiency ……………………… 109
6.3 Theoretical Sampling ……………………………………………………. 111
6.4 Theoretical Sorting ………………………………………………………. 113
6.5 Conceptualization ………………………………………………………... 114
6.6 Existential Phenomenological Perspective …………………………… 116
7. Study Results – Concepts …………………………………. 117
7.1 Concept One – Models …………………………………………………. 117
7.2 Concept Two – Training …………………………………………………. 133
7.3 Concept Three – Support ………………………………………………. 139
7.4 Concept Four – Perspective ……………………………………………. 146
7.5 Concept Five – Truth ……………………………………………………. 155
7.6 Concept Six – Feelings …………………………………………………. 163
7.7 Concept Seven – Patterns ……………………………………………… 175
7.8 Concept Eight – Boundaries ……………………………………………. 185
8. Recommendations for a Model …………………………… 194
9. Existential Family Therapy Model for Alcohol Problems 197
10. Psychotherapy Contributions ……………………………. 202
10.1 Communicating My Research …………………………………………. 205
10.2 Presentations ……………………………………………………………. 206
10.3 Journals …………………………………………………………………. 206
10.4 Social Media ……………………………………………………………. 207
11. Strengths and Limitations of the Research ……………. 208
12. Reflections on My Research ……………………………… 210
13. Conclusions …………………………………………………. 212
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14. Bibliography ………………………………………………… 217
15. Appendices ……………………………………………………. 232

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1. Introduction

‘We should treat with indulgence every human folly, failing and vice, bearing in mind that what we have
before us are simply our own failings, follies and vices. For they are just the failings of mankind to which
we also belong and accordingly we have all the same failings buried within ourselves. We should not be
indignant with others for these vices simply because they do not appear in us at the moment’.
Arthur Schopenhauer.

1.1 Structure of the Thesis

Chapter 1 provides the introduction to the thesis and an explanation of my personal
journey to starting the research. It also covers the aim of my project which was to
create a model that is existential phenomenological and assists those with drinking
problems to improve their wellbeing through family relationships. I explain my
struggle with finding the appropriate terminology to describe someone often referred
to as an alcoholic, a name I see as a label that can create shame and guilt.

Chapter 2 is the literature review that I have divided into three sections. The first is a
review of the main themes and principles within the field of addiction and alcohol
abuse in particular. It covers a neurobiological perspective, DSM-5, Alcoholics
Anonymous, Cognitive Behavioural Therapy and Counselling in general. Secondly,
the literature in which existential phenomenological psychotherapy is described in
relation to addiction. This includes descriptions of definition of self and addiction as a
social construct. Thirdly, family therapy literature that appears to have some affinity
with an existential phenomenological modality and includes systems theory and
structural approaches.

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