Tuesday, May 22, 2007

Twenty Three Research Topics In Person-Centred Therapy

Entry for 19 May 2007; completed 22 May:

Offered by participants at “Research as a Growing Edge for the Person-Centred Approach: Issues and Opportunities”, Workshop given at PCT Scotland Twentieth Anniversary Conference, May 2007. Used by permission.

Topics identified by focusing on areas of curiosity. The person’s emotional reactions to the topic are provided in brackets. Some participants produced multiple topics. My commentary is given under each topic in italics.

Note to participants: I have tried to set the topic descriptions as accurately as my notes and memory allows; if I have got yours wrong, please let me know so I can correct the description. Also, please take a look at the commentary and suggestions I have added beneath your topic. Feel free to post comments!

1. Time-limited counselling is a reality, for example, in EAP work. What’s the evidence for how much & how often is effective?
Robert: See dose-effect research, e.g., Howard, K.I., Kopta, M., Krause, M.S., & Orlinsky, D.E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41, 159-164.

2. Critical appraisal of the development of PCA in Britain. Any radical political impact? [Emotional reaction to topic: guilty, self-indulgent]
Robert: It might be useful to try to open up this question: What are the political and social effects, if any, of the development of the PCA in Britain? This might need to be investigated using sociological methods.

3. Is PCT the long-term most cost effective for government funders [burning]
Robert: In order to assess cost effectiveness, you have to determine the economic (monetary cost) of achieving specific effects (e.g., people returning to work or improving by a .5 mean scale points on the CORE). “Long-term” would mean tracking these effects over time (e.g., for 5 years after therapy).

4. Fragile process & culture: What is the relation between fragile process and culture? What are the implications of culture for training in working with fragile process (vs. western, middle class)? Change cultural context in which training occurs: What are the effects of this on work with fragile process?
Robert: I think I’d want to start with the first part of this: What does fragile process look like in different cultures? How do different cultures regard & treat fragile process?

5. Who do we miss? Who are the people who we don’t reach, or who don’t reach out to us (e.g., men). Also, how we miss people (cultural/social) in the moment through sexism etc. Being on the edge, don’t want to go. What factors? What is the role of referrers in this?
Robert: Maybe identify people who were/are clinically distressed but who don’t seek therapy (community surveys always identify a large number of people like this). Interview them about what keeps them from seeking help.

6. What things enable therapy to be more accessible (e.g., for attracting higher percentage of men)?
Robert: This is the complementary question to no. 5. Maybe interview men whose profile suggests that they would be unlikely too seek help, and ask them how/why they got there.

7. What helps us be OK with difference as therapists?
Robert: I assume this means something like, how do therapists cope with working with clients who are very different from them in various ways, e.g., culturally or in terms of gender, sexual orientation, social class, or disability.

8. What do my clients think of me? [emotional reaction: self-centred, guilty]
Robert: You could use the Helpful Aspects of Therapy Form after each session; the Change Interview after part or all of therapy. See www.experiential-researchers.org/instruments.html

9. What do my clients make of being in therapy? What do they think is happening to them?
Robert: See topic no. 8, especially the Change Interview.

10. Supervision: What is effect of supervision? How does it work? What is the evidence?
Robert: This is an active Research Front. I’m particularly fond of the program of research by Nick Ladany and others, which has adapted research methods from qualitative research on client therapy experiences for studying supervision. For example, see a recent book: Critical Events in Psychotherapy Supervision: An Interpersonal Approach, by Nicholas Ladany, Myrna L. Friedlander, & Mary Lee Nelson. Washington, DC: American Psychological Association, 2005.
As for the last question above, see: Handbook of Psychotherapy Supervision, edited by C. E. Watkins, Jr., 1997.

11. How clients experience me? [difficult to stay with curiosity]
Robert: See topics 9 & 10.

12. I find it difficult to contemplate how to go about doing research. Who is tere available to help? What about funding? How do I start?
Robert: These are important questions about the research process and bridging the research-practice gap. Linking with some kind of community is important, I believe. Banding together with other like-minded practitioners is one strategy; another is connecting to a research centre on a volunteer basis.

13. Ways of coming at the world: Some clients come to therapy looking for practical solutions, while others come interested in exploring ideas for their own sake. I am interested in the the interaction between the therapist’s way of coming at the world and the client’s expectations and experience of world. [In this processm, nothing came, I felt like an interloper. It’s hard to describe]
Robert: The topic of the interplay between client and therapist views of the world is often tackled using discourse analysis of therapy texts. That is, the researcher collects transcripts of qualitative interviews or therapy sessions in which there is some revealing of ways of coming at experience and seeing the world, especially points of clash or discrepancy in world-view/approach. Then one looks closely at the text to see what is revealed and other client and therapist manage to negotiate the discrepancy. Issues around clients who expect and want the therapist to act as an expert and person-centred therapists who eschew such as role would a be particularly rich environment to study this.

14. Clients who come looking for practical solutions; how they understand my offer might change over the course of therapy. How can I present my offer to clients more effectively?
Robert: See topic 13. In addition, your interest in the practical aspect of handling this situation makes this appropriate for Task Analysis of how PCT therapists handle this situation more vs. less effectively.

15. I work in a GP setting alongside CBT pilot project. We are supposed to devise an outcome questionnaire. [This feels like a head bit; emotionally, I have a flat response to this; it is something to do out of necessity.]
Robert: Necessity is important, too, but then I always wonder if there is some way of making it more interesting. Perhaps an individualized change measure, such as the Personal Questionnaire, or a qualitative approach to outcome, such as the Change Interview? Or some kind of change that you think is particularly important to look at? On the other hand, maybe what’s needed is some simple way of measuring outcome, such as with the CORE, which could leave you free to go on this something that you find more interesting, like topic 16.

16. What is it that I do, what happens in the room that the client finds helpful? [I felt surprised to be asked about my curiosity. This topic feels like it has energy, gives me enthusiasm, is doable, nonacademic, and personalized; even I could do that! This topic is more about curiosity than necessity.]
Robert: See topics 8 & 9. You can see that this is a really a key issue of therapists.

17. What do my clients make of being in therapy? Also, what do they make of my perspective, which could be quite different? How do these two perspectives match & differ?
Robert: See topics 8, 9 & 16 regarding what clients find helpful. Also topics 13 & 14 regarding how clients come at therapy and the therapist and how client-therapist differences in approach and worldview get played out in therapy. Qualitative interviewing can be useful here, as can discourse analysis of points of reveal discrepancy in view and approach.

18. Therapist use of language that has invitational sensitivity to client experiencing.
Robert: I assume that you are interested what this kind of invitationally sensitive language sounds like in therapy sessions. This is a great topic for discourse analysis or conversation analysis, in which you collect and transcribe examples of this kind of talk, probably from early sessions of PCT and study it.

19. The client’s experience of the process between client and therapist: I’m interested in surprising feedback, where the client’s experience is far more than I realize.
Robert: One approach to this would be to collect examples of sessions in which striking discrepancies can be detected, such as when client and therapist ratings or reports of therapeutic alliance in the session or the effects of the session on the client are quite discrepant. Then, using various qualitative and quantitative methods, one could study these sessions to try to figure out what was going on.

20. What am I worth financially as a therapist? What do people (clients, service providers) think I worth? What criteria do clients and GPs use to decide how much counselling is worth? This is a market/costing issue. What is my comparative worth relative to other mental health staff? [This feels like a burning issue]
Robert: See also topic 3. There are various costing methods, and the issue is very current, as a Google search of the terms “cost effectiveness psychotherapy” will reveal. You will notice that one approach is to try to figure out the cost of untreated psychological problems in terms of lost work productivity and reduced quality of life; then it becomes possible to show that therapy can pay for itself by reducing other costs, both monetary and psychological.

21. How can we build social capital in order to make therapy redundant and unnecessary? How can we change society so there is less need for therapy, throught outreach, prevention, education, improvements in parenting practices and so on? [This feels like a slow burn of interest]
Robert: This is a large part of the focus of the community psychology movement, where there is a strong emphasis on reducing the causes of poor mental health (=primary prevention) and early detection and treatment before problems get worse (=secondary prevention). A key idea in contemporary community psychology is psychological sense of community; see Wikipedia article: ttp://en.wikipedia.org/wiki/Sense_of_community, which has various components such as membership, influence, integration and fulfillment of needs, and shared emotional connection. Sense of community is like therapeutic alliance, but at the level of the person’s relationship with their community. For an overview of ideas about social capital, see Wikipedia article: ttp://en.wikipedia.org/wiki/Social_capital. I think that community psychology has rich collection of theory and interventions that speak to this topic.

22. I am interested in the young counselor just starting in training, and the use of basic, extended residential encounter groups in training. What new methods are there for studying these?
Robert: Old methods for studying the outcomes and change processes of encounter and large group experiences would also be useful to apply: Pre-post designs with psychometrically-sound, theoretically appropriate measurement instruments such as the Strathclyde Inventory are still needed. Qualitative interview methods such as the Change Interview and Helpful Aspects of Therapy Form could also be easily adapted for this purpose. Of course, research on the effects and change processes in psychotherapy and counselling training courses is also very much needed.

23. Classical and experiential approaches to PCT: How do advocates of classical/nondirective and experiential/process-guiding approaches to PCT experience each other, and themselves in relation to each other? What do they want from each other? How do they experience conflicts with each other? What do they feel would be needed in order to reduce these conflicts? [Emotional reaction: sadness, fear, moving toward hope-
Robert: This was my unexpected topic. I think it would be really interesting to interview advocates on both sides about this. I’ve elaborated the research questions a bit further, moving them toward interview questions.

1 comment:

Nick Gulliford said...

21. How can we build social capital in order to make therapy redundant and unnecessary? How can we change society so there is less need for therapy, throught outreach, prevention, education, improvements in parenting practices and so on?

Please see www.talk2me.org.uk

Best wishes