Sunday, December 21, 2014

Book Chapter by Muntigl et al on Empathic Practices in Person-Centred Therapy

I've now read the parts of a book chapter by Muntigl and colleagues (available on Google Books, see link at bottom of this entry). This is a very interesting conversation analysis study based on videos from the person-centred arm of Greenberg et al.'s York Depression studies comparing person-centred to EFT.  There is some really nice stuff here, i.e., "troubles telling" as "empathic opportunity", and five kinds of empathic response favoured by person-centred therapists: naming another's feelings, gist formulations, upshot formulations, and co-completing another's utterances, and nonverbal following responses.  Some of these are newly described.  They also describe the precision with which nonverbal following responses are offered in response to indicators of the client's affectual stance.  I particularly liked their discussion of the delicate epistemic stance of person-centred therapists. 

I realise that few person-centred therapists are into conversation analysis, but I think that this sort of analysis really captures to how good person-centred therapy and counselling actualy works.  I would like all my students on our Person-Centred Postgrad Diploma Counselling at Strathclyde to know this stuff, and I wish I could develop some sort of research input for the course on this.  It's also very relevant to EFT practice, which is based on person-centred empathic work as its baseline. 

As a side-note, one of our MSc students, Catherine Cowie, recently completed her dissertation on the same topic, so it will be useful for us to compare her results to those of Muntigl et al.  In the meantime, I'll just give the reference here and add my endorsement to this line of research: 

Muntigl, P., Knight, N. & Watkins A. (2014). Empathic practices in client-centred psychotherapies: Displaying understanding and affiliation with clients.  In E-M. Graf, M. Sator & T Spranz-Fogasy (eds.), Discourses of Helping Professions (pp. 33–57). Amsterdam: John Benjamins Publishing.

Author summary: DOI: 10.1075/pbns.252.03mun
Google Books extracts:

Sunday, December 07, 2014

Do Biological Explanations of Psychological Difficulties Reduce Empathy in Mental Health Professionals?

Interesting report in the Proceedings of the National Academy of Science (USA) about a series of clinical perception analog studies in which mental health practitioners were given written vignettes of clients/patients with common mental health difficulties (schizophrenia, depression, social phobia), and then randomly given either biological or psychosocial explanations for the person's problems. (I thought the explanations were quite well done and evidence-based.) After that, they were asked to rate their feelings toward the client on 6 relational emotions (including "warm, compassionate, sympathetic"), labelled by the researchers as "empathy". 

Results: The researchers said that they had expected that the biological explanations would make practitioners more sympathetic to the hypothetical clients.  Instead, they were surprised to find that the so-called empathy ratings were higher when practitioners were given psychosocial explanations (e.g., trauma, poor living conditions, family conflict) than biological explanations (e.g., family history of the problem, MRI results.) 

I think that humanistic psychologists will not be surprised by these results, since this is consistent with what we have been warning of for years. Still, it is a sobering finding for those of us who do like to dabble in neuroscience (e.g., brain correlates of empathy).  However, I think that what is really going on here is that the psychosocial explanations provided a more coherent narrative for the person's problems, locating them within the person's life history and context to a much greater extent that the biological explanations did.  Empathic, caring emotions are much easier to access within a narrative context. 

Sunday, September 21, 2014

The Scottish Independence Referendum: An American Expatriate Perspective

--> Entry for 21 Sept 2014:

People have been asking me about the current mood of people in Scotland in the wake of the Scottish Referendum vote last Thursday.  Many people in Scotland have been surprised to learn that American citizens living in Scotland could not vote, but nevertheless that was the case. As a result, Diane and I were bystanders to this process, caught in the middle of an historic event but able to do little except share our views and encourage people who could vote to do so.

I think that for most people this was a very personal choice:  It was interesting to see how the different people in our circle made up their minds. People from England living in Scotland voted predominantly No, because of their sense of vulnerability as an often-resented minority; some English people we know were so afraid of independence that they had vowed to move back to England if the Referendum had succeeded.  You voted No if you thought that independence was going to threaten your livelihood (eg if you worked in the finance industry), your pension, or your research grants; if you didn’t trust Alex Salmond and the Scottish National Party; or if you were just generally risk-averse.

In the same way, you voted Yes if you felt adventurous; longed for or idealized the rational social democracies of Scandinavia and imagined that an independent Scotland would follow their example; felt overlooked, short-changed, alienated by the Westminster government in London; if you didn’t like having nuclear weapons parked down the Clyde from where you live; or if you just didn’t trust the Conservative-Liberal Democrat coalition (or the Labour Party for that matter) to act in the best interests of Scotland.  This appears to have been more the case for young people than people our age.  In the end, it is easy to imagine that most people who voted Yes did so from a genuine sense of doubt and fear that the three main parties in Westminster have either the will or the means to come to an agreement any time soon about further devolution for Scotland. 

And for us, as foreign nationals living in the UK, it was difficult not to be strongly swayed by the increasing xenophobia of the ruling coalition, as evident in their anti-immigrant policies and Eurosceptic views.  We were (and still are) afraid that the Westminster government is going take the UK out of the European Union while making foreigners like us feel even more unwelcome.  So we too were strongly influenced by our sense of vulnerability but saw an independent Scotland as a potentially friendlier place for us to live.

Yes and No supporters in Glasgow found themselves in the particularly puzzling place of being in a city that had voted Yes while because the rest of Scotland went for No.  Perhaps that sense of dissonance explains why violence broke out in George Square on Friday night (it was quickly contained).

So what is the current mood of the people of Scotland?  I think that most of us are relieved that the whole long, loud messy business is done with (for now anyway).  Beyond that, it depends which side of the Referendum you ended up on:  Folks who had voted No were greatly relieved that the Independence Referendum didn’t pass, thus sparing them from the negative outcomes or uncertainties they had envisioned.  On the other hand, many folks who voted Yes are feeling pretty let down.  Other Yes supporters, however, are vowing to fight on for greater devolution and autonomy for Scotland.

But in any event now we know that in spite of the many real uncertainties about what independence might bring, fed by the scare tactics of the No campaign, and the last-minute three-party promise of significant further devolution, 45% of the 85% of eligible Scottish voters were still willing to leave the UK.  Moreover, some very large but as yet unmeasured proportion of those voting No were in favour of further devolution, seeing that as a safer path to increased Scottish autonomy than a precipitous leap into independence.  In other words, it’s pretty clear that a large majority of the people of Scotland want to see change from the status quo of under-representation and dominance by the overly-centralised British Government; the main disagreement is over how much and how fast. 

For now, everyone, Yes- and No-supporters alike, is watching Westminster to see if the powers that be will allow themselves to be dragged into further devolution by Gordon Brown (the former UK Labour Prime Minister who has taken this on).  The day after the Referendum, Alex Salmond announced he will step down as head of the SNP and thus as First Minister of Scotland (from a US perspective, think State Governor but in a parliamentary system). This appears to be intended to allow his successor (probably Nicola Sturgeon) a free hand in continuing to push for devolution, or failing that, to begin planning another independence referendum. What all this means is that this is not over, for either Scotland or the UK.  Is anybody ready for English Devolution?

Tuesday, August 26, 2014

Questions & Answers about Emotion-Focused Therapy (EFT) and Social Anxiety

Entry for  26 Aug 2014:
 This was written some time ago for a mental health organisation website, but unfortunately never saw the light of day.

1. Can you say a few words about how you became interested in researching social anxiety and about your therapeutic approach?

Emotion-Focused Therapy (EFT) -- not to be confused with the “Emotional Freedom Technique” – is a humanistic approach to psychotherapy or counseling that is similar to Person-Centred Counselling but is more structured and combines a genuine, caring, empathic relationship with specialized techniques to help clients deal with specific issues that they bring to sessions.  These issues, referred to as “tasks”, include internal conflicts, unresolved relationship issues such as emotional injuries, puzzling personal overreactions to situations, and problems finding the most useful level of emotions.

EFT was originally developed as a treatment for depression in the late 1980’s, before being extended to trauma in the 1990’s.  However, there is a large overlap between depression and anxiety, so EFT therapists have always had to work with anxiety alongside other presenting problems.  Furthermore, many clients who present with traumas such as childhood mistreatment suffer from PTSD, which is usually regarded as a type of anxiety problem.  Building on this earlier work, in the past 10 years EFT therapist-researchers in the Canada, Ireland, Israel and Scotland have begun turning their attention to anxiety as a main presenting problem.

2. How is EFT different from other approaches in working with social anxiety?

Social anxiety is fear of other people, most commonly fear of speaking or doing things in public and fear of close relationships with others.  The main other approach to social anxiety is cognitive-behaviour therapy (CBT).  CBT focuses on the dysfunctional thoughts or beliefs that generate social anxiety, as well as the avoidance or safety behaviours that maintain it.  EFT sees dysfunctional thoughts and avoidance behaviours as the result of underlying emotion processes, such as “anxiety splits” in which one part of the person tries to induce fear in order to prevent perceived social dangers.

3. What is the evidence that EFT is effective in working with social anxiety?

We’ve just completed a reasonably large study with socially anxious clients, comparing EFT to person-centred counseling.  Clients in both treatments showed substantial pre-post improvements, but clients in EFT improved more, especially on measures of social phobia and the particular issues they wanted to work on.  Our results also suggest that we got better at working with social anxiety as the study progressed, as we developed and refined our approach, especially in the EFT arm of the study.  We are currently writing this study up for publication but a preliminary report was published last year in the journal Person-Centered and Experiential Psychotherapies.

We’ve found that some socially anxious clients benefit from an unstructured nondirective approach; however, we’ve also found that many others have trouble coping with unstructured social situations and therefore seem to do better with more structure and focus in their treatment.

4.What can a client expect to happen when they engage in Emotion-Focused Psychotherapy?

The first few sessions of EFT are fairly similar to Person-Centred Counselling (from which EFT is a development):  The therapist begins by trying to establish a genuine, caring and empathic relationship.  However, for clients with social anxiety who are afraid of unstructured one-to-one situations EFT therapists try to offer more structure at the beginning, until they feel safe with the therapist.  Also, EFT therapists tend to provide more information about the nature of therapy and social anxiety.  As therapy progresses, EFT therapists listen very carefully for what the client is bringing into each session to work on, such as being puzzled about why they get so anxious around other people, or self-criticism, or unresolved feelings from having been bullied when younger.  These are examples of EFT “tasks”, specific pieces of the social anxiety that can be worked on bit by bit, using specific techniques such as “replaying” a social anxiety episode like it was a movie to recapture triggers; or having an imaginary conversation with your internal critic or even with the people who bullied you.  The therapist never imposes these ways of working on the client, but does offer them as things that EFT therapists have found to be helpful with clients.  The therapist also tries to leave time at the end of each session for helping the client set aside any painful emotions that they might have gotten in touch with, and also for reviewing what has been accomplished in the session and what might be next in therapy.  In the end, however, the therapeutic relationship comes first, both because it is healing in itself and because it provides a safe situation for the client to work productively on the difficult or painful experiences that are at the heart of social anxiety.

5. How long is a course of treatment?

The version of EFT that we’ve developed for social anxiety at the University of Strathclyde lasts up to 20 X 50-min sessions.  Although some clients require fewer sessions or more sessions, most are able to make productive use of the available sessions.

6. Do you have a few helpful strategies or tips for someone suffering from social anxiety?

First, the thing about social anxiety is that everybody from Freud to your gran knows that the only way to get over being afraid of other people is to spend time hanging out with them until you stop being so afraid.  The problem, is how do you get yourself to do that, when you’re so scared? 

Second, self-acceptance is a very important part of recovery from social anxiety.  EFT is an acceptance-based therapy, like mindfulness. We say, “You have to arrive at a feeling before you can leave it.” It’s important to accept the fact that you are afraid of other people; this is the starting point.

Third, it’s useful to try to change emotion with emotion, to begin to move past simply focusing on being afraid of the horrible things that might happen with other people.  So it’s very useful to discover other feelings you might have:
·      Self-reflective curiosity about what your underlying feelings are and how this social anxiety stuff works for you
·      Connecting sadness at missing out on human connection
·      Protective anger at past unfair treatment or violations of your boundaries
·      Self-compassion for all the difficult things you’ve been through and the sad and lonely parts of you.

These are a few suggestions for beginning the journey of recovering from social anxiety.  However, because social anxiety comes from and involves relationships with other people, it is best treated within a safe, empathic, genuine relationship, whether that’s a counsellor/psychotherapist, parent or partner.

Thursday, July 24, 2014

PCE Conference in Buenos Aires

Entry for 24 July 2013:

Wonderful PCE conference in Buenos Aires!  I was overwhelmed by friendliness and care of our Argentine hosts. The weather turned cold (3C this morning), but that did not take away from the warmth of our Latin American colleagues.  High points:
• Unstructured large group (150 - 200 people) that inevitably ended up focusing on intercultural issues, some tragic, like the Malvinas-Falkland War and the Fukushima accident, other charming like the young American grad student who said she was going to tell her father how nice all the people she met were.
• The charming conference site (a private primary school with small desks that made me feel like I was 10 again).
• Keynote talks by the likes of Charlie O'Leary (who charmed everyone's socks off) and Shoji Murayama (who reviewed 50 years of building a person-centred community near Kyoto).
• A varied and interesting program that included sessions by Margaret Warner's session on fragile process and fragile relationships (including a very personal and moving account of her own journey) and Sylvia Lombardi's very helpful sessions on doing PCE therapy via Skype (just to pick two idiosyncratic choices)
• Oh, and my two presentations went very well, also:  The Counselling for Depression Workshop was popular enough that many people were very disappointed when they had to be turned away (they asked me to repeat the session on Thursday morning but unfortunately I had to miss the final half day of the conference), while the session on the Personal Questionnaire content analysis study was also well attended and successful, in spite of research not really being the South American PCE therapists’ thing.
I’ve heard many wonderful stories over the past few days, and hope I will be able to remember some of them, because many were very much worth retelling.  The sequential translation in large group and break out sessions provided me with a Spanish crash course, so that by the end of the conference both my receptive and expressive Spanish had greatly improved.  This should be very helpful as we move on to Ecuador today for several days of EFT training in Quito.  I’m looking forward to coming back to South America again before too many more years have passed.

Sunday, June 01, 2014

Prospects for the Next Year: An I Ching Reading on Turning 64

Entry for 1 June 2014:

My brother Willy reminded me that 64 is the number of hexagrams in the I Ching, the ancient Chinese book of divination. His email gave me the idea of consulting it about the prospects for the next year: Unfortunately, I left my yarrow stalk oracle (actually they are chicken skewers but they work just fine) in Ohio. However, it's all on line now, and I found a yarrow stalk oracle site I kind of liked, although I'm not completely sure of the readings (as usual). 

Any way, I got hexagram 37, Jia Ren/The Family, moving to 33, Dun/Strategic Retreat/Save your bacon. I don't remember ever seeing either of these hexagrams before back in my I Ching consulting days in the late 1960's/early 1970's. 


Hexagram 37:  Wind over Fire: The Family: There is a lot here about first protecting one's family, however that may be defined, by perseverance even in hard times.


Hexagram 33: Heaven over Mountain: Strategic Retreat: This then moves to making sure to hang onto the valuable essential things that sustain one's life. 

 Together, these seem like really good advice!

Saturday, May 31, 2014

Dundrennnan Abbey Adventure on my Birthday

Entry for 31 May 2014:

Many, many warm thanks to all my friends and family who have wished me happy birthday in various way. We had lovely Adventure near Kirkcudbright visiting Dundrennnan Abbey, a ruined 12th century Cistercian abbey with wonderful stonework.  As is so often the case for us, the high point was our interaction with the Historic Scotland docent/caretaker.  Glyn, an enthusiastic retired stone mason from Yorkshire, kept dragging us around the site to show one wonderful piece of stone work or architectural feature after another.  
 Right before we left, he took us to an iron gate in the south side of the cloister, which he said had been the door to the kitchen at some point:  "Do you seen that bottom stone on the right side of the door frame?, " he asked, pointing to a lovely carving of flower that stands out against the straight vertical groove carved through the stack of stones there.  "That were just some guy who decided one day to cut t' stone that way.  He didn't get paid for it, he just did it to say he were here.  And here he still is, you can read him in t' stone, all these hundreds of years later!"  The big smile on Glyn's face showed his vicarious pride, empathically resonating with his fellow craftsman across more than 800 years.