Emotion-Focused Therapy Classified as Counselling by NICE

Entry for 5 December 2009:

In my comments at the New Savoy Conference on Psychological Therapies in the NHS, I gave a version of my rant about the new Revised NICE Guidelines for Treatment of Depression, which had been thoughtfully placed in all delegate packs. What I said was:

(a) there is a need to relook at NICE’s weighing of the evidence, such that it gave infinite weight to RCT’s and zero weight to everything else; and (b) NICE wasn’t even following its own evidence guidelines, as witnessed by their not even looking for studies on Person-Centred or Emotion-focused therapy in their computer-based search strategy, and then ignoring perfectly good RCTs on Emotion-Focused Therapy even after these had been brought to their attention.

I based my comments on having revised the summary recommendation document. The final published version of the recommendations on Counselling has been reformatted (mainly by lumping it together with brief psychodynamic psychotherapy) but is unaltered from the draft version distributed earlier this year for comment. It reads as follows:

1.5.1.4 For people with depression who decline an antidepressant, CBT, IPT,

behavioural activation and behavioural couples therapy, consider:

• counselling for people with persistent subthreshold depressive

symptoms or mild to moderate depression

• short-term psychodynamic psychotherapy for people with mild to

moderate depression.

Discuss with the person the uncertainty of the effectiveness of

counselling and psychodynamic psychotherapy in treating depression.

Based on this, I mistakenly assumed that the NICE reviewers had totally ignored the vigorous commentary from BACP, which included the evidence on EFT for depression that I had provided.

A few days ago, however, I received an email from Les Greenberg about a request for more information about these recommendations from Klaus Pederson, a Danish psychologist involved in setting policy for that country on treatment of depression. He wanted to know why EFT was lumped with counselling in the new NICE guidelines. That can’t possibly be true!, I thought, and went and downloaded the complete guideline from the NICE site.

Much to my surprise, I found the following in their review of the evidence for Counselling:

Page 219:

Three new studies (GREENBERG1998, GOLDMAN2006 and WATSON2003) that met the inclusion criteria were found in the update search. … Two studies, GREENBER1998 and GOLDMAN2006, are not listed in Table 52 given that these compare two different types of counselling.

Page 222-23:

The comparison of counselling versus CBT was included in one study (WATSON2003). There is insufficient evidence (only one small-sized study with wide CIs [=Confidence Intervals]) to reach any certain conclusion about the relative effectiveness of these two treatments (for BDI [=Beck Depression Inventory] scores post-treatment: SMD [=Standardized Mean Difference] 0.04; 95% CI -0.38, 0.47)…

Two studies, GREENBERG1998 and GOLDMAN2006, compared two different types of counselling (therefore are not included in the tables above). GREENBERG1998 examined the effectiveness of client-centered counselling versus process-experiential counselling. The evidence indicates that there was no significant difference between treatments in reduction of self-reported depression scores (SMD 0.13; 95% CI, -0.57, 0.82). GOLDMAN2006 compared client-centered counselling with emotion-focused counselling. The results favoured emotioned-focused therapy (BDI scores: SMD 0.64; 95% CI -0.02, 1.29). These two studies are small in size and therefore results should be interpreted with caution.

… In addition to the limited data available for counselling interpretation of the results is complicated by the different models of counselling adopted in the studies. For example, Bedi2000 and Ward2000 follow a Rogerian client-centred model of counselling, Simpson2003 a psychodynamic model whereas the studies by WATSON2003, GREENBERG1998 and GOLDMAN2006 adopt a process-experiential/emotion-focused model which is compared in the latter two trials to the client-centred model of Rogers.

It is difficult to know what to say about this dismissal of the evidence for EFT with depression. The three RCTs were certainly enough to get EFT added to the list of empirically supported therapies in the United States, but here in the UK the NICE review committee has written it off as a form of generic counselling! The criticism of the different models of counselling in the last paragraph is particularly annoying because of course the NICE reviewers created the problem by lumping these therapies together in the first place.

I wrote the following back to Les:

I commented on an earlier version of this draft and supplied information on three RCTs on EFT for depression. I note that this revision appears to have been done hastily by throwing EFT in with a miscellaneous collection of studies of counselling. No other therapy for depression appears to have suffered this sort of indiscriminate treatment; the EFT RCTs are dismissed as involving small samples, even though this criticism has not been lodged against comparable CBT studies. … Having spoken with various people associated with the NICE work on this guideline, I can verify that it [the revised NICE Depression Guideline] is conceptually and empirically sloppy; [therefore,] the Danish Reference Program should not follow this. For example, they [NICE] do not distinguish different kinds of counselling and even include psychodynamic counselling along with EFT under the same heading. It is clear that the committee that did this work was dominated by CBT and psychopharmacology supporters, who do not really care to understand what humanistic therapy is or the nuances between different forms of either counselling or humanistic therapy.

I have two further comments at this point:

1. The Mental Health Providers Forum, a consortium of 60 mental health charities (including both counselling services and service user advocacy groups), has set in motion a process to investigate the process by which these and other NICE guidelines have been constructed and to develop alternatives. I have been invited onto the Scientific Committee of the Mental Health Providers Forum, a task force of psychotherapy and mental health services researchers led by Michael Barkham. We had our first meeting 10 days ago, the day before the New Savoy conference, and will be looking at the science end of things. But it’s now clear that science isn’t going to be enough here: The cavalier treatment of the EFT evidence makes it clear that the NICE review committee is perfectly capable of changing the rules on the evidence to suit the conclusions that they have already decided on. Scientific evidence is critical here, but so is political action!

2. Ironically, the end result of this biased review process is that counselling -- now explicitly including Person-Centred counselling and Emotion-focused Therapy – is nevertheless “in the NICE guidelines”. For example, in his speech at the New Savoy conference the Health Minister simply referred to treatment “recommended by NICE” without specifying what the level of the recommendation was, then referred to counselling as one of the treatments that now need more emphasis. Doubly ironically, UKCP’s Humanistic and Integrative Psychotherapy brand, which they have gone to great pains to distinguish from counselling, is not included.

New Savoy Conference Focus on Wellbeing

Entry for 27 November 2009:

A clear emerging trend at the New Savoy Conference on Psychological Therapies in the NHS was a greater focus on Wellbeing (WB), of particular interest for us in the Counselling Unit because of ongoing discussions about the possibility of a departmental restructuring plan that might have us as part of a Department (or something) of Health and Wellbeing. We heard about WB in the inspiring opening talk by Cary Cooper (current President of BACP). We heard about WB in a speech from Andrew Burnham, Secretary of State for Health. Lord Layard talked about WB. There was a workshop on WB, which I attended. There was a session on enhancing WB in children and young people. And finally there was a session on WB in older adults. So WB was a major focus on the conference. However, it was much harder to tell exactly what was meant by WB. On the one hand, all mental health problems were being put under the heading of WB, which simply amounts to a trendy repackaging of Business as Usual. On the other hand, some presenters tried to go beyond relabeling distress as (absence of WB) by pointing to early intervention and prevention.

The detection/prevention angle seems to me to be a more legitimate use of the term WB, but left me with two thoughts. First, I was left with a large sense of déjà vu: Haven’t we been here before? Wasn’t this the main point of the community psychology movement of the 1970’s? When I was in graduate school, a lot of very bright people like Seymour Sarason, Julian Rappaport, George Albee, and many others spent a lot of time talking and writing about things like primary prevention (preventing problems from emerging in the first place), secondary prevention (identifying emerging problems in at-risk populations and addressing them before they get worse), and, in distant third place as not very good at all, tertiary prevention, which is pretty much business as usual: Working with individuals with full-blown problems, presumably to keep them from getting even worse or recurring in the future.

Second, over the course of the conference, it became clear to me that most of the people talking about WB were of the first variety, the repackagers. That is, we (and I do include myself) don’t really have a clue about how to do prevention. We are experts at psychotherapy/counselling, that is, the poor cousin, the tertiary brand of prevention; this is what we do and this is what we are good at. Turn us loose on prevention programs and we are out of our depth and more likely to do more harm that good. For example, early identification programs can end up stigmatizing kids through singling them out for intervention. Even more disturbing is what happens when psychologists or others try to intervene without doing the proper research beforehand. Again I speak from experience, having worked for several years in Toledo on an ill-conceived school-based anti-violence program.

One of the few presenters who illustrated what I would consider to be a well-grounded approach to WB was Sube Bannerjee, Professor of Mental Health and Aging at King’s College London, who gave a wonderful talk on developing programs for people with dementia, based in part on research on the trajectories by which people end up in care homes for dementia. However, based on what I heard at the conference it seems to me that what is really called for are well-targetted systemic interventions to prevent the worst effects of dementia. I think that there is a role for us, but it begins to look like Dot Weak’s and Pam Courcha’s research on teaching Pre-Therapy Contact Work to nurses and caregivers makes more sense than conventional counselling or psychotherapy.

Bridging the Research-Practice Gap with Systematic Methodological Pluralism

Entry for 27 November 2009:

For this year’s New Savoy Conference on Psychological Therapies in the NHS, Michael Barkham invited me to take part on a panel on evidence and the research-practice gap. As I thought about what I would say in my allotted 4 slides/10 min, I remembered a couple of lines from William Blake that I have loved since coming across them as an undergraduate in 1971. I looked the poem up and immediately realized how perfect the poem was for what I wanted to say. Here is the text version of my Powerpoint slides:

1. William Blake on Methodological Pluralism:

Now I a fourfold vision see,

And a fourfold vision is given to me:

'Tis fourfold in my supreme delight

And threefold in soft Beulah's night

And twofold always. May God us keep

From single vision and Newton's sleep!

(Letter to Thomas Butts, 1802)

2. Systematic methodological pluralism

a. Danger of “single vision”: Universal fallibility of knowledge practices

b. Points to need for multiple lines of evidence:

•To support practice

•To speak to different stakeholder groups

•To further science

c. Convergent operationism (Donald Campbell): Bringing multiple line of evidence to bear on a topic

3. Key Psychotherapy Research Methods Address Different Research Questions and Speak to Different Stakeholders

a. Randomized Clinical Trials:

•Research Questions: Test Causal models (internal validity)

•Stakeholders: Trialist Scientists (scientists who believe that RCTs are the one true way to evidencing a therapy; experimentalists)

b. Change process research:

Involves getting inside the “black blox” of therapy; including process-outcome, helpful factors, significant events and sequence analysis studies

•Research Questions: Develop causal models; Test causal models

•Stakeholders: SPR Scientists

c. Naturalistic effectiveness research:

Practice-based research (e.g., Michael Barkham and the CORE team)

•Research Questions: Establish generalizability to practice (external validity)

•Stakeholders: Policy-Makers/ Commissioners

d. Systematic case studies:

For example, Hermeneutic Single Case Efficacy Research (HSCED): looks at causality at the single case level

•Research Questions: Describe practice; Show what is possible; Test causal claims at an individual level

•Stakeholders: Practitioners

e. Qualitative/narrative research (first person accounts):

•Research Questions: Capture a sense of the lived experience of a therapy

•Stakeholders: Service Users

4. Blake’s Pluralist Epistemology Compared to Key Psychotherapy Research Methods

The Twofold Always:

1. Outer: Scientific-Objective-Observational: Randomized Clinical Trials; Naturalistic effectiveness research

2. Inner: Experiential-Subjective-Phenomenological: Qualitative/Narrative

The other forms of vision:

3. Unconscious: Interpretive-Tacit-Emergent : Change Process Research (getting inside the change process)

4. Transcendent: Spiritual-Immanent-Epiphanies: Systematic Case Studies (Most therapists are secular, so for them, the epiphanies occur with particular clients)

Commentary/further discussion:

1. Converging lines of evidence vs. range of convenience. In his presentation, Tony Roth, citing the American Psychologist George Kelly, raised the issue of the range of convenience of the different methods, suggesting some kinds of research may not be appropriate for addressing certain kinds of questions. This is certainly an implication of this framework. However, this turns out to be more complicated in actual practice: Thus, three different types of research all have a strong role to play in making causal inferences linking therapy to client change: (1) RCTs; (2) Systematic Case Studies (specifically, HSCED research; and (3) Change Process Research.

RCTs provide an operational method for justifying causal inference, but fail in themselves to satisfy the plausible explanation condition for causal inferences, and are subject to various ills ranging from differential attrition to researcher allegiance effects. Change Process research is actually a family of different types of methods that attempt to fill in the missing mediating processes linking therapy to outcome, or to test for the presence of hypothesized mediating processes. Systematic Case Studies (at least the HSCED variety) also seek to get inside the change process, but at the level of single cases.

Accumulating consistent evidence from these three different types of therapy research provides a set of converging operations that can provide a more solid basis for inferring psychotherapy efficacy, even though the questions they address differ. Beyond these, moreover, Naturalistic effectiveness research and Qualitative/narrative research can also play supportive roles in supporting causal efficacy claims for a psychotherapy: An efficacious therapy will show strong pre-post effects (especially persuasive with chronic problems) and will attract client narratives testifying to the experienced effectiveness of a psychotherapy. Each of these approaches provides evidence that bears on the broad question of effectiveness/efficacy, creating a network of linked evidence supporting the theory of a therapy’s effectiveness, what Cronbach and Meehl (1955) called a nomological net.

2. I got a real kick out of Roz Shafran, who teaches CBT at the University of Reading. In her presentation, she argued passionately that an excellent example of how to bridge the research-practice gap is work on key processes in Obsessive-Compulsive difficulties, including prolonged exposure and response prevention, thought-action fusion, contagion propagation, and the memory disrupting effects of repeated checking. These are all processes that were identified in practice, tested and refined through experimental laboratory research, and then fed back into practice as within-session therapeutic experiments. (These are analogous to EFT tasks.) During the question period, I said that I’d love to use change process research methods on this therapy, such as doing qualitative interviews. Roz responded, “Let’s work together!”, and I reached over and shook her hand; the audience applauded.

3. A few minutes later, someone in the audience, perhaps in an attempt to burst the panel’s bubble of pluralistic unanimity, asked the question that we’d all being avoiding: what we thought about NICE’s use of evidence. Although Tony ducked the question, Roz and I gave differing views, with her defending NICE and me criticizing its use of evidence. I’ve since learned that the situation with NICE is a bit more complicated, a topic that I intend to take up in a later blog entry. Shortly after that, the session ended, but the connection remains, and I look forward to further dialogue with Roz and others, such as Shirley Reynolds (who teaches at U of East Anglia and who I know from Sheffield days in the mid-1980’s).

Third New Savoy Conference on Psychological Therapies in the NHS

Two years ago, I attended the first New Savoy Conference on Psychological Therapies in the NHS, engineered by Jeremy Clarke in the wake of the Improving Access to the Psychological Therapies initiative, which had appropriated 172 million pounds to a scheme to move people off of the unemployment and disability rolls by offering them CBT for anxiety and depression. In a blog entry I wrote at the time, I discussed the tension and bad feelings that were rife at this earlier conference; this so struck me that, along with M., I started a dialogue with Tony Roth and Steve Pilling, which resulted in our involvement in the Humanistic Competence Expert Reference Group (also documented extensively in this blog). I didn’t go last year, from sheer overwork and because I wasn’t invited to speak, but Michael Barkham invited me to be part of a panel, so I was happy to come along this time.

What a difference two years can make! The mood of this conference was very different: While not always amicable, it was much less confrontational. Resentments and concerns remain, and bubbled to the surface from time to time, but there was a real sense of movement openness and dialogue. Here is my personal list of emerging trends and highlights: (I’ll discuss the greater focus on wellbeing separately in a later entry.)

1. Opening IAPT for nonCBT therapies? I think the biggest news is that the parties running IAPT (the Improving Access to Psychological Therapies initiative) are now promising to include a wider range of therapies including Interpersonal Psychotherapy, Brief Dynamic Therapy, Couples therapy, and Counselling. Andrew Burnham, Secretary of State for Health (=Health Minister) said this to us in his speech on Thursday, also noting that all therapies listed in the NICE guidelines would be included. This introduced some ambiguity into the government’s position, because brief dynamic therapy and counselling are only included in the revised guidelines (published last month) as a last resort therapy for clients who decline CBT or IPT, and then only with a health warning about the lack of evidence. But I guess this means that Counselling (still not defined) is being considered as inside the fence, which puts it in a better position that EFT, still ignored in spite of RCTs. Similarly, we took it as a good sign that Andy Burnham also referred to “getting the most out of experienced workforces of counsellors and psychotherapists”, many of whom lost their jobs when they were supplanted by IAPT CBT workers. Indications are that in many places, these workers were subsequently hired back in IAPT programs, often after brief top-up CBT training.

2. Update on the IAPT evaluation. Back at the beginning of the IAPT initiative, Glenys Parry, Michael Barkham, Gillian Hardy and their team at Sheffield landed the contract to do the independent evaluation of the IAPT pilot sites in Doncaster and Newham (an area of London). Glenys presented an update on their progress on Thursday, apologizing for the lack of outcome data, which due to various circumstances are still being analyzed. In addition, they are still collecting data from their matched control cohorts. She did present some fascinating audit, qualitative and organizational data. It is already clear, for example, that the program has succeeded in delivering services to a significantly larger population of clients; in other words, the IAPT program has in fact Improved Access to Psychological Treatments, as advertised. Glenys went on to describe qualitative data on helpful (many) and hindering (relatively few) aspects of the program. She also pointed to the crucial role of good IT systems for managing both treatment and data analyses. The outcome data are expected to be available in 6 months or so and should be worth the wait.

3. Life span view: Delivery of services was described in various sessions for children/young people, in the workplace (adults), and older people. This yielded a much more balanced coverage of the range of client populations that is generally present at an SPR conference, and so very informative presentations.

4. Acceptance of the importance of research and measurement of therapy outcome: A huge shift here compared to two years ago. The issue now is not whether but how, and what should be done in addition to quantitative outcome monitoring. Michael Lambert, Wolfgang Lutz and Dave Richards did a useful session: Mike Lambert reported that there have now been two successful RCTs on the usefulness of providing feedback together with a set of clinical support tools, that is, further assessment instruments to evaluate the cause of a therapy being off track (these include therapeutic alliance, social support, motivation for change).

In addition, Dave Richards reported an emerging critique of the Stiles et al (2006 & 2007 studies), in the form of intent-to-treat analyses of these data, which show much smaller effect sizes than the completer analyses. Intent-to-treat analyses deal with missing posttherapy scores by carrying forward the last available data point and using it to replace the missing data, even if this is the pre-therapy score. This method is used in RCTs to deal with the internal (i.e., causal) validity threat of selective attrition, that is, distortions in outcome results due to clients in different treatment conditions differentially dropping out. This is the first time I’ve heard of intent-to-treat analyses being used for nonrandomized pre-post designs. Like intent-to-treat analyses more generally, this one only addresses the effects of assigning clients to therapy, not the effects of therapy itself.

5. Anti-stigma initiative. The New Savoy Declaration, the constituting document for these conferences, was modified to add anti-stigma language, and the issue of stigma and what to do about it was a recurring theme. At a reception on Thursday night, mental health user advocates previewed a sophisticated new advertising campaign, which seems to me to have a greater potential for success than previous campaigns have had to date.

6. Continuing role and voice of service users. One of the best things about the New Savoy conferences is the strong role played by mental health service users. This is far different from any of the other conferences that I go to and makes a refreshing change. One of the high points of the conference occurred on the panel of mental health issues in older adults: A service user named Bill Davidson, a very articulate retired former head teacher, was speaking when the panel chair passed him a note saying that his time was up. He took the note, looked at it, set it down, and said to the audience, “I’m a service user -- that means I can talk as long as I want!” The audience applauded.

7. The voluntary sector. Another thing I noticed this year was that more attention was being given to the voluntary sector, that is, mental health charities or nonprofit counselling and advocacy services, recognizing the vital role these counselling services and advocacy organizations play in the mental health sector.

8. Continuing dialogue with CBT therapists. As was the case two years ago, the conference again provided an opportunity to talk with various CBT types. I think that we tend to get quite insular in the PCE approach, only talking among ourselves. So I welcomed the chance to talk further with Tony Roth, Shirley Reynolds, and Roz Shafran, and look forward to continuing these conversations.

Real Therapy vs. In Treatment: The Role of Repetition

Entry for 21 November 2009:

We loved watching the American/Israeli television series, In Treatment, which preoccupied us for two months this past September-October as we patiently watched the 40+ episodes at a rate of 5/week, just as it was intended to be watched. However, one thing that I found a bit disturbing was the fact that the therapy sessions in the TV series appeared to be no more than 20 minutes long, less than half the standard therapy session duration of 50 minutes.

After we finished watching In Treatment we decided to take a look at the real thing, and began working our way through Les Greenberg’s Emotion-Focused Therapy Over Time set of 6 sessions, with additional spoken commentary by Les. After a bit of experimentation we decided that the best way to properly appreciate these is to watch the first 25 minutes of a session, then to go back watch it again with Les’ commentary. In this manner we determined that we could get though a session in two evenings. At this point, we’ve reached the halfway point, having finished session 3 in both versions.

Part of the fun of watching this series is that we know Les, but the fact is, the series is very good: The client, a psychiatric survivor with multiple hospitalizations feels absolutely real, just like the clients that we often see in our clinic settings. She talks at Les, she externalizes, she starts to change then gets ahead of herself, crashes and gets stuck. Les does great work, too good in fact for my students today in EFT-2, who felt de-skilled and intimidated. He also messes up (occasionally) and gets frustrated.

But the thing that struck me when comparing Les’ work (and my work as a therapist also) is the amount of repetition in comparison to In Treatment. That is, there is very little repetition in In Treatment, but there is a lot of repetition in Les’ and my work. When something is stuck we go over it a couple of times, just to see if it will get unstuck; when something new comes out, we repeat it at least twice, and even ask the client to repeat it. Repetition Rules!

It’s easy to see why there is relatively little repetition in In Treatment: The writers were afraid of boring people and wanted to fit a session into a half-hour slot. They were afraid to put too much repetition into the script, because they thought it would rob the program of dramatic vitality. The result is what my grandmother used to call “giving it the fictional treatment.”

In fact, repetition may be an important – but overlooked – aspect of therapy. Once, during the late 1980’s, I was showing Les and Laura a video of my work with a client from the Toledo Depression Project. I complained that I couldn’t understand why my client was still struggling with an issue that we’d already worked over in therapy a couple of times. Les quoted a Gestalt therapy maxim to the effect of, “You have to work through an issue seven times before it sticks.” More generally, it seems to be important that new information be repeated in order to give the client time to let it soak in, that is, to reinforce or consolidate it. Cycling through material repeatedly gives the client more time to process an experience. For example, it is common for new details or connections to emerge when a client with post-traumatic stress difficulties tells their trauma narrative again. Repetition is part of a process of slowing down and dwelling that can be important for helping the client to dig deeper into their experience and to access key emotion schemes and the experiences associated with these.

So repetition can be important in therapy, and is yet another example of a quite broad principle of information science: Redundancy signals importance. In other words, if you want to communicate that something is important, repeat it as many times as it takes to boost its salience to the level desired.

Also, as the Danish theologian Kierkegaard once said, there is no repetition, which means that nothing gets repeated exactly, so you never know when something important is going to jump out, almost by chance, the third time around. And this is an example of another important principle, this one from complexity theory: Self-organizing processes tend to develop by capitalizing on chance, waiting for something new and important to fall out randomly, and then going with it. Complexity scientists think that complex, self-organizing processes, from galaxies to life to brains to cultures, develop in this way. Why not our clients too?

November Steps: Variations on a theme by Takemitsu

Entry for 14 November 2009:

The temperature drops as Autumn progresses, first from 10-15 Celsius, and now in the past week, varying between 5 and 10 Celsius. The trees lose their leaves, too, in stages, rowan, birch, elm and finally oak. And the days grower shorter, as if counting down by steps also, imperceptible until we notice we've lost more hours of daylight: 12 hours (solstice)... 10 hours (mid October)... in a few days, our daylight will drop to 8 hours... before gradually settling toward 7 hours at winter solstice.

These are our November Steps, as we descend into late Autumn. The phrase from the title of a wonderfully evocative piece of music by Japanese composer Toru Takemitsu for traditional Japanese instruments (biwa, shakuhachi) and orchestra.

November is an appropriate time for letting go, for grieving what cannot be and had lived only in the life of our imaginations; it is also a time for feeling grateful for what is possible and real, that is, for giving thanks (thanksgiving). In fact, I think that these two movements of the psyche are really the same movement: to let go of what has passed (or was never more than a hope or dream) is to be grateful for what is there for us now. I have been trying to live this these past few weeks, living in a way that feels both sad and at points even mildly depressed, as if in mourning; but paradoxically this November state of mind at the same time seems affirming, grounded, peaceful.

Saturday Adventure: Campsie Glen

Entry for 14 November 2009:

This week's Saturday Adventure: Campsie Glen, north of Glasgow, above Clachan (=village) of Campsie. Valley-canyon cut into the Campsie Fells by the Glazert Water, in full spate after recent rains. Waterfalls cascading down the glen, some from side streams running off the bracken rust-coloured moorlands on either side of the glen.

Every time I go out for a run here, I run up Cleveden Road to the top of the hill, before descending steeply to the canal. From the top of the hill, for just a few minutes, I’m usually able to see the Campsie Fells before me, about 10 miles to the north. Sometimes (but not too often) they stand out bright in the morning sun. Sometimes they are completely obscured by cloud. Usually, like this morning, they are somewhat indistinct, shaded by clouds or mist.

On a clear day, the westernmost hill of the Campsie Fells stands out from the rest stretching away to the east. I have heard locals refer to the Campsies as the “sleeping soldier”, although this phrase is more commonly used to describe the island of Arran. The westernmost hill is the head of the soldier, and it’s the part I generally see most clearly as I reach the top of Cleveden Hill and start down the other side.

As is often the case on Saturdays, we got off to a late start and reached Clachan of Campsie only about 2 in the afternoon. It was very quiet. We hiked up the glen, along the Glazert Water, not very far, because the path is blocked by warning signs borne by quite large carved wooden hands. We turned around, came back, poked around a couple of the small shops and the old graveyard, with its tumbled-down chapel and grass- and moss-covered grave stones. We stopped at the little café/gallery there and had tea, hot chocolate and a plate of cheeses, oatcakes and a small salad. Then, with darkness already starting coming on at a bit before 4pm, we drove over to Lennoxtown, where we turned up the Crow Road driving a mile or two until we reached a vista point overlooking the Campsie Glen and its surrounding countryside. This is another nearby place that is definitely worth further exploration, not far at all from Glasgow, but wild-feeling, dramatic and beautiful.