Thursday, June 28, 2007

Comments on “Increasing the Availability of Evidence-Based Psychological Therapies in Scotland”

Entry for 28 June 2007:

National Health Service Education for Scotland (NES) is a governmental body whose board is appointed by the Health Minister of the Scottish Executive. Alex McMahon, Head of Mental Health Delivery and Service for NES recently issues a document entitled, “Increasing the Availability of Evidence-Based Psychological Therapies in Scotland”. This document lays out what is referred to as a “‘Phase 1’ Plan”. Here is a summary of this plan:

A. The Proposed Plan. The plan focuses largely on drastically increasing the training of CBT therapists in Scotland.

This is justified to begin with by referencing the Scottish Executive Health Department (SEHD) report 'Delivering for Mental Health' (2006; ), and in particular,

"Commitment 4 - We will increase the availability of evidence-based psychological therapies for all age groups in a range of settings and through a range of providers."

There are two parts to the plan:

1. A scoping exercise, which is in progress, which involves consulting a wide range of people, health boards, mental health professions, users etc..

2. A plan for training 50 more Cognitive Behavior Therapy (CBT) practitioners, more CBT supervisors etc.

The focus on CBT is justified as follows:

"The rational for focussing on CBT in the first instance is based on its recognised effectiveness across a wide range of settings, its applicability across all tiers of service provision, and its record for generating effective, low intensity approaches to 'mild-moderate' problems which provide realistic alternatives to anti-depressant prescribing. "

Toward the end of the report, reference is made to including other approaches to therapy at some later date, and possibly for later stages of a stepped care model.

B. Beginning of a Response:

Here is a start at crafting a response to proposed plan; I would welcome additional suggestions and input!

The proposed plan appears to be flawed in several ways, but the overwhelming emphasis on CBT is puzzling and a cause for concern. What is needed is a clear, reasoned set of arguments, and a plan to disseminating those arguments.

1. The SEHD mandate emphasizes a variety of practitioners, but the current plan focuses exclusively and narrowly on CBT. This is not in keeping with the Scottish Executive’s position as reflected in Commitment 4.

2. The proposed scoping exercise fails to include a review of the scientific evidence, relying instead on the assertion that that CBT is effective. This is not a tenable scientific position, and in fact is at variance with the NICE Guidelines for treatment of depression and anxiety, which emphasize the need for a variety of psychological and psychopharmacological treatments.

3. The plan fails to acknowledge the available scientific evidence, which suggests that a variety of therapies are effective for common psychological problems such as depression and anxiety. These therapies include psychodynamic, person-centred/experiential, and family therapy. For example, a large recent naturalistic study by Stiles et al. (2006), of patients seen on primary care settings in the UK, found equivalent outcomes. (This study has since been replicated with an even larger sample and tighter methods.) In general, major reviews and meta-analyses of the research evidence going back more than 25 years indicates that the major therapeutic approaches are roughly equivalent in their effectiveness for common psychological problems. This means that it is unscientific to focus on only one therapeutic approach.

4. The plan points to the need for low-intensity (i.e., nonintrusive, inexpensive) treatments for depression and anxiety, but fails to mention the existence of the most widely available, effective, low intensity treatment, namely, psychological counselling (e.g., King et al., 2000). If the SEHD wishes to rapidly deploy a significant number of low-intensity psychological therapists for treating, for example, mild to moderate depression, they need look no farther than the existing pool of trained, experienced counsellors in Scotland!

King, M., Sibbald, B., Ward, E., Bower, P., Lloyd, M., Gabbay, M., & Byford, S. (2000). Randomised controlled trial of non-directive counselling, cognitive-behavior therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care [Monograph]. Health Technology Assessment, 4 (19), 1-84.
Stiles, W.B., Barkham, M., Twigg, E.., Mellor-Clark, J., Cooper, M. (2006). Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings. Psychological Medicine, 36, 555–566.

Wednesday, June 27, 2007

Report on SPR-Madison-2007

Entry for 25 June 2007 (returning from the USA):

Memories. The international conference of the Society for Psychotherapy Research has been the high point of my scientific year since I attended my first meeting in 1976. That experience was life-changing: Suddenly, I was confronted with all the people I’d been reading: Hans Strupp, Irene Waskow (later Elkin), Sol Garfield, Ken Howard, David Orlinsky. I also met others whom I later came to know well: Laura Rice, Len Horowitz, Les Greenberg, Mike Lambert. I heard Mary Smith make the first presentation of the now-famous psychotherapy outcome meta-analysis (Smith, Glass & Miller, 1980); Sol Garfield was in the small audience of about 10 people and declared, “I’m not sure I understand all the numbers, but it certainly sounds good!

Experiencing the absence. These and other memories came back to me during this year’s meeting in Madison, Wisconsin, on the shore of Lake Monona. In part, this stemmed from the memorial session held for Hans Strupp at the very end of the conference (after the final plenary in fact), and also because Madison had been the site of my second SPR conference, the one at which I met Clara Hill, Karla Moras, Lorna Benjamin, and others. This conference was notable for me and others for the absence (for various causes) of several key SPR figures, among them Les Greenberg, Irene Elkin, Bruce Wampold, Lorna Benjamin, Larry Beutler, Hartvig Dahl, and Hans Strupp. Psychotherapy research really began to flower during the 1960’s and 1970’s, with the early APA psychotherapy research conferences and then the founding of SPR. Increasingly, the aging process is catching up with many of these founding figures; many are becoming infirm; and, it seems, with every year more of my friends and SPR colleagues are dying. As David Orlinsky noted this year, “There has been so much loss”.

Distinguished Career Award 2007. Another sign of the generational process is the movement of the Distinguished Career Award into my generation: This year’s award went to Clara Hill, who was cited for, among other things, developing Consensual Qualitative Research. Her citation was touchingly read out by two of her former students, an indication of the loyalty and respect with which her students regard her leadership and inspiration. Hers is a gift, I think, of being able to discern promising emerging directions in psychotherapy research and then to attack these with incredible focus, determination, and teamwork. Although I taught her most of what is today known as Consensual Qualitative Research, she has done far more with it than I ever could have, and through her efforts and those of her students has had a huge impact on North American qualitative therapy and counselling research. Congratulations, Clara!

Return of CBT and opportunities for dialogue. One of the most promising signs at this year’s SPR meeting was the return of CBT therapy researchers. In particular, Steve Hollon and Rob DeRubeis featured prominently in the program, but there were others as well. I had a couple of very interesting and enjoyable conversations with Steve and Rob during the conference, and count these contacts as one of the high points of the conference. For years, the SPR leadership has been bemoaning the absence of opportunities for dialog with CBT advocates, but I think it has taken the efforts of Louis Castonguay and others, and in particular the therapy principles project, jointly sponsored by SPR and APA Divisions 12 (Clinical) and 29 (Psychotherapy) (Castonguay & Beutler, 2005), to bring about a change in the field in which dialog has become more possible.

Open Discussion on Models of Change. A good example of this emerging dialog was the set of open discussions hosted by Jacques Barber, in which representatives of different theoretical orientations were asked to make 5-minute presentations of their model of the change process in therapy, including references to research support for particular elements of their theory. A tall order! (Ironically, we have been asking this question – minus the research support – of applicants to our new Counselling Psychology doctoral course. What’s good for the goose is good for the gander…)

This turned out to be a nerve-wracking but ultimately highly informative and stimulating exercise. In the session in which I presented, Chris Muran started things off by presenting the Safran-Muran interpersonal psychodynamic alliance rupture model. Next, I presented a general model of the change process based on the General Task Model of PE-EFT. After I did my brief spiel, Jacques floored me by asking how clients get from stage 4 (newness emerges from dialectical exploration) to stage 5 (awareness, insight or positive transvaluation). This is equivalent to asking how gamma rays cause protons to break into K-mesons when they hit them; in other words, this is a version of one of Zeno’s Paradoxes. I stood there for a moment, transfixed, thinking to myself, “It’s turtles all the way in!” before admitting that I wasn’t really sure and falling back on the cloud chamber analogy of tracking particles coming in and out. (Later, of course, I thought of at least two reasonable things to have said: (a) newness automatically generates these things; (b) the emotion process automatically generates these things. But I’m not particularly happy with these explanations either…)

After me, there was Gary Diamond, who presented a lovely task analytic model of the resolution of communication breakdown between suicidal/depressed adolescents and their parents. So far, I felt we were all basically on the same page, given that I could assimilate both Chris’ and Gary’s models into my generic change model. Then, Steve Hollon and Rob DeRubeis respectively presented behavioral activation and cognitive therapy accounts of change in depression. I found their models to be interesting and reasonably complex and sophisticated, especially in their approach to therapeutic difficulties There was really relatively little to disagree with.

Afterwards, Jeanne Watson and I stuck around for awhile talking to Steve and Rob about what they would do in various clinical situations. What struck us was that they (especially Rob) find it essential to activate client emotions in order to be able to help clients develop either new behaviors or new cognitions. In the end, we all agreed that this had been fun and illuminating … and overdue. Wouldn’t it be great, we wondered, to next look at each other’s actual practice and comment on it? I suggested that we apply our various research tools for describing client processes and therapist responses. An idea for next year in Barcelona?

Other personal highlights:
-Presenting with Jutta Schnellbacher (from KU Leuven) the results of our interpretive discourse analyses of first session Helpful Aspects of Therapy (HAT) data (client postsession descriptions of significant events). It was a joy to see her enjoy her first international SPR conference.
-Presentations on qualitative research on Motivational Interviewing by Henny Westra (York U in Canada) and Allan Zuckoff (Western Psychiatric in Pittsburg). I was so impressed by their research, that I invited them to put together a proposal to do a special issue of Person Centered and Experiential Psychotherapies.
-Program stream on case study research chaired by Dan Fishman. (I was especially struck by a paper by Ron Miller applying the Federal Rules of Evidence to case study research, but the other papers were nice also.) These sessions clearly illustrate the ways in which interpretive case study research is rapidly developing.
-Lovely paper by Ann Doucette on Rasch Analysis of the OQ-30, clearly presenting the basics of the Rasch family of analysis tools and extending the method to reliable clinical change and other topics.
-Great dinners out with Jeanne Watson, Rhonda Goldman, Neil Watson, Chris Muran, Mike Lambert, Louis Castonguay, Michelle Newman, various students and others.
-Being asked by Susan Reynolds of APA Books to put together a proposal for a workbook to go with Learning Emotion-Focused Therapy. (“It’s a good time to do this,” she said.)
-Memorial session for Hans Strupp, with touching presentations by Tim Anderson, Karla Moras and others. I had brought the poem about Hans that I read last October at the North American SPR meeting in Burr Oak (see Poems section of this blog), but hesitated to read it until the end. (Afterwards, Katerine Osatuke, told me it made her cry even though she’d never met Hans, and the nice man who had been running the audio-visual equipment came up and thanked me. Karla later told me that he had told her that the previous day had been the 10th anniversary of his father’s death.)

Reference: Castonguay, L., & Beutler, L. (Eds.) (2005). Principles of therapeutic change that work. Oxford, UK: Oxford University Press.

Sunday, June 24, 2007

Personal Commentary on: Change Process Research: Realizing the Promise

Entry for 24 June 2007:

Every year, the Program Chair for the Society for Psychotherapy Research International Conference (who is also the President-Elect of SPR) gets to design one or two plenary sessions. This year, I was pleased when Jacques Barber exercised his prerogative by inviting me to present in the final plenary session on current challenges and possibilities for therapy process research. However, I was extremely busy before I left Scotland, with the end of the Diploma course and the analyses for the paper that Jutta and I were to present, so I didn’t really have enough time to feel that I had adequately prepared for this, my highest-profile presentation of the conference.

The night before the conference, I was just settling in to do some serious work on this presentation, when my oldest son Brendan, who had made a last minute visit back to Toledo, decided that he needed to have a long talk with me. This was just like the old days when he was in high school and used to poke his head into my study as I was trying desperately to finish a lecture. As always, how could I refuse him? (It was a really good talk…)

On arrival in Madison, I learned that there had been a rash of last minute illnesses; Jacques informed me that two of the 4 presenters for the final session had had to cancel. That left Rob DeRubeis and me to hold the fort, which significantly increased the pressure. I wrote most of the talk on Wednesday afternoon in my hotel room, but I was unsatisfied with it and worked on it on and off over the next three days, around my other presentations and going to sessions. I ended up tinkering it right up until 5 minutes before the beginning of the session, adding examples and trying to tie in things from earlier in the conference.

In the end, much to my surprise, it was very well received and many people asked for copies. Rob’s talk followed mine and I was also pleasantly surprised at how well it dove-tailed with one of my main points, i.e., that the process-outcome change process research genre is greatly over-used and needs to be supplemented with other approaches.

The source of much of my anxiety was that I was not prepared to present concrete examples of what I was talking about. However, I didn't really have time to present detailed examples, so this turned out to be mostly the product of my over-active/perfectionistic critic. The strength of the talk probably lay primarily in my presenting a clear, relatively straightforward taxonomy of research approaches, without larding it down with confusing details. It is yet another example of how I tend to do my best work under time presure when I don't have time to obsess too much!

Change Process Research: Realizing the Promise

Entry for 23 June 2007:

Reference: Elliott, R. (June 2007). Change Process Research: Realizing the Promise. Paper Presented at meeting of the Society for Psychotherapy Research, Madison, Wisconsin, June 2007

[Conversion of Powerpoint slides follows; see next entry for personal commentary on this presentation:]

Change Process Research (CPR): Definition
-Term introduced by Greenberg (JCCP, 1986)
-The study of the processes by which change occurs in psychotherapy
-How change occurs
-In particular: The in-therapy processes that bring about client change
-Update: 20 years later

Role of Change Process Research
-Necessary complement to:
-Randomized clinical trials (RCT) and
-Experimental or interpretive single case causal designs
-These focus narrowly on establishing existence of a causal relationship between therapy and client change
-But do not specify the nature of that relationship
-Also, causal relationships will not be accepted unless there is a plausible explanation or narrative linking cause to effect
-CPR can provide and support these explanations

Review of Main Genres of Change Process Research
A. Basic Genres:
1. Process-Outcome
2. Helpful Factors
3. Micro-analytic Sequential Process
B. More Complex Genres:
4. Task Analysis
5. Comprehensive Process Analysis
C. Outline:
-Recommendations/ Innovations

1. Process-Outcome Genre (Quantitative)
a. Description:
-Includes correlational & experimental designs
-E.g., transference interpretations -> Outcome
b. Appeal:
-The most popular genre; intuitively obvious, easy to design
-Works well with measures of good process (e.g., depth of client exploration, alliance)
c. Challenges:
-Therapist responsiveness affects key theory relevant therapist processes (e.g., interpretation, chairwork, homework)
-Limited by area of dose-response curve sampled
-Correlational design challenged as subject to third variable causation, not currently accepted by several major review schemes
-Process-outcome gap limits clinical application
d. Recommendations/ Innovations:
-Should be accepted but only as one line of evidence for Evidence-Based Practice (EBP)
-Use new psychometric techniques (Rasch/IRT) to improve predictor & criterion validity
-Within-case analyses?
-Combine with other methods (e.g., Task analysis)

2. Helpful Factors Genre (Qualitative)
a. Description:
-Includes Consensual, Grounded Theory, Narrative etc.
-Post-therapy (Change Interview) or post-session (Helpful Aspects of Therapy Form)
b. Appeal:
-Intuitively obvious
-Fits with mental health consumer movement (“Ask the client”)
-Draws on current popularity of qualitative research in professional training programs
-Rapidly maturing
c. Challenges:
-Attributional errors; clients may follow cultural scripts
-May not be aware of or able to describe important processes
-Poor interviewing (e.g., leading questions) and superficial data analysis appear to be common => “flat” or misleading results
d. Recommendations/Innovations:
-Should be accepted but only as one line of evidence for EBP
-Develop methods for qualitative research integration (qualitative meta-analysis, e.g., Timulak, 2007)
-Encourage deeper, more interpretive or critical analysis, better training for qualitative interviewers
-Combine with other methods (e.g., interpretive single case designs)

3. Micro-analytic Sequential Process Genre
a. Description:
-Generally quantitative; usually theory-testing
-E.g., therapist empathy -> client experiencing
b. Appeal:
-Useful for testing practice theories
-Very close to practice: if X, then Y
-Study causal influence processes directly
c. Challenges:
-Distance from therapy outcome
-Third variable causation may operate
-Difficult/time-consuming: selection, transcription, measurement, analysis issues
-Not particularly good for discovery-oriented research
-Has never really caught on; field has moved away from
d. Recommendations/Innovations:
-Should be accepted but only as one line of evidence for EBP
-Qualitative micro-analytic sequence analysis is underdeveloped and should be used more widely: e.g., Conversation Analysis of important processes or events
-Combine with other methods (e.g., Task Analysis, Comprehensive Process Analysis)

4. Task Analysis of Key Therapeutic Processes/Events
a. Description:
-Focused, rational-empirical mixed method research strategy (Rice & Greenberg, 1984; Greenberg, 2007)
-Combines: qualitative/quantitative micro-process sequence analysis; process-outcome; helpful factors
-E.g., Narrative Retelling Task
b. Appeal:
-Useful for explicating therapist implicit knowledge
-Close to practice; useful for building clinical micro-theories
-Defines program of research across studies
-Can relate process to outcome
-Uses pluralistic, converging operations
c. Challenges:
-Complexity; not suited to one-shot investigations
-Based on a specific model of therapy as task-focused/client as active change agent
-Micro-analytic element is difficult/time-consuming
-Under-utilized; has not really caught on
d. Recommendations/Innovations:
-Should be more widely used to construct rational models of good practice
-Initial therapist qualitative interview phase under-utilized & should appeal to qualitative researchers as an initial step

5. Comprehensive Process Analysis of Significant Therapy Events
a. Description:
-Focused, inductive mixed method approach (e.g., Insight events in psychodynamic & CBT; Elliott et al., 1994)
-Significant events typically identified by clients and on the basis of successful outcome, but can use rational criteria also
-Use with or without client tape-assisted recall data
-Combines: helpful factors, interpretive qualitative analysis, qualitative micro-process, quantitative outcome assessment,
b. Appeal:
-Uses pluralistic, converging operations within single study
-Yields rich understandings of significant events
-Close to practice; useful for building clinical micro-theories
-Useful source of analytic tools for other approaches (e.g., Stiles’ Assimilation Model)
-Flexibility: can be used to study a wide variety of therapies and types of events
c. Challenges:
-Time-consuming/complexity/technical difficulty (requires mastery of range of methods)
-Under-utilized; has not really caught on
d. Recommendations:
-Advocate small-n use for student research projects in professional training programs, as alternative to qualitative interview research
-Should be more widely used to construct rational models of good practice

-Many of Change Process Research genres have proven useful over the past 50 years of therapy research
-Some have been over-used at the expense of others
-However, all have serious limitations and face various challenges:
-Fallible, partial approaches to understanding how change occurs in therapy
-Or: Are time-consuming and technically difficult
-Thus, Change Process Research methods have not fully realized their potential to contribute to our understanding of how clients change.
-Future progress is likely to benefit most strongly from a more balanced approach that builds on several recent developments, among them:
-More careful, deeper qualitative methods
-Advances in psychometric methods (Rasch analysis)
-Interpretive case study methods (events or cases)
-Overall, what is needed is systematic methodological pluralism requiring multiple lines of evidence to provide a more sound foundation for the evidence-based practice of psychotherapy.

Monday, June 18, 2007

A Few Modest Proposals for the Counselling Diploma Courses

Entry for 18 June 2007:

When I started here at the University of Strathclyde, I realized that I would need to spend much of my first year observing how things are done, before making serious proposals for doing things differently. It has proved to be somewhat difficult at times for me to hold myself back, as my supervision group found, but mostly I have asked lots of questions and tried to fit in.

Now, however, I have followed the training through a yearly cycle, and am preparing for my second post-course Diploma team meeting. So the question is, what changes do I think are called for? Here is an initial list, organized by course component:

A. Research Training:
1. Increase the amount of research input from 15 to 30 hours.
I think this is important for several reasons: (a) Research training is going to be a much more important part of training under counselling regulation; it is important to begin the process now in order to be able to do it more gradually. (b) I don’t think that we are doing of good job preparing students for doing an MSc thesis/dissertation; more input would help with this. (c) A key issue for teaching research on the diploma course is that many students have no previous training in research, including statistics; furthermore, many are suspicious or fearful of math. This means that it is important to back up and address basic issues of research readiness, which could be called “pre-research” (like “pre-therapy”). Pre-research training needs to explores attitudes toward research, help students locate their research curiosity, and generally deal with fears and anxieties in order to help students develop an open relationship with research. All research inputs should be experientially grounded, e.g., teach quantitative research via filling out, scoring, and interpreting the Strathclyde Inventory. It would be a good idea for Research training to be connected to ongoing research projects in the Counselling Unit, including the Diploma Course Outcome Study, which presumably many of the students will be taking part in next year.

2. Add some kind of systematic data collection to the Paper 4 requirement, of the student’s choosing (could be qualitative or quantitative or both).

3. Make the research study group a formal, graded assignment.

4. Encourage (but don’t require) students to take part in the various research protocols at the Counselling Unit.

B. Taught Inputs and workshops:
4. Make the other therapy orientation group presentations a group assignment for everyone.

5. Make consistent, general use of a variety of video- and live examples, for practically all inputs, including theory inputs.

6. Add inputs on counselor response modes (more commonly known as “skills”), integrating these with relationship attitudes and experiences.

C. Experiential elements:
7. Focus initial skill training on specific counselor response modes and processes in a structured sequence (e.g., different types of empathy, tasks); then continue skill training throughout the course as part of supervision groups.

8. Make intentional rather than unstructured use of the Large Group; continue the process of clarifying the purpose and functions (“tasks”) of the Large Group; e.g., relational ruptures work; group problem-solving; dealing with endings.

Sunday, June 17, 2007

The Return of the Long-Lost Dad

Entry for June 17, 2007:

I got up at 5am British Summer Time (midnight in Ohio). It was broad daylight: the sun had risen at 4:28. Mikio had insisted upon driving me to the airport (for which I was very grateful), so he picked me up at 6:30, and I was off on my trip back to the US.

I had been up until 12:30 am the night before, doing the things one does before one leaves on a trip: cleaning the bathroom; backing up computers, charging all the little electronic devices, uploading photos, and of course packing. So I was pretty tired as I waited for my flight at the gate at Glasgow Airport, trying to finish my Self-Appraisal entry before we left.

But at the same time I was excited and pleased in anticipation of seeing my kids and Diane. It had been five months since I had seen Kenneth, Brendan & Mayumi, the longest I had ever gone without seeing them, and Diane had come over ahead of me almost 4 weeks earlier, to look out after Kenneth after he got out of college for the summer.

The flight to Newark was relatively easy: Mostly, I graded an MSc thesis and dozed from time to time, listening to my iPod. We were a bit late arriving, so I had to rush – insofar as that is possible with the long line in Newark – to get to my connecting flight. However, when I tried to board, I learned that the airline had without telling me decided that I wouldn’t make the connection and so had given away my seat! After some wrangling and more waiting, they finally let me on the plane, ahead of some standby would-be travelers, and I was set for my final leg… or so I thought.

Thunderstorms (“thundery showers” in the UK) are a common occurrence this time of year in the eastern US, and there was a line of them to our immediate west. After taxiing on the runway at Newark for an hour, we finally got permission to fly south around the thunderstorms. Apparently, in order to save fuel, circuitous routing is now frowned upon in the US; various passengers around me complained unhappily about the delay, and the new restriction on Americans’ freedom to go anywhere they want at any time. But finally, we got our permission and were on our way to Detroit.

The flight was uneventful, taking us over the familiar sights of Pennsylvania, Ohio, Lake Erie, Ontario and finally Detroit. As we flew in over the south suburbs of Detroit, I could see the grid pattern of big and small roads, outlining sprawling neighborhoods, strip malls, and big box stores, so different from Glasgow’s irregular density. So large yet so fragile, I saw it as an artificial thing, powered by the illusion of cheap fossil fuel. How many more years, I wondered, will we be able to sustain this level of energy consumption?

We landed out of the east at Detroit Metro Airport on a runaway I don’t remember having come in on previously. But we were quickly at the gate, and I was soon striding rapidly down Concourse B, through the tunnel to the main concourse (with its light sculpture of shifting, flashing lights and rumbling new age sounds), eager to bridge the minutes until I would be with Diane again… She was waiting at baggage claim; I practically ran to her, kissed her and picked her up into the air in a large hug, over her embarrassed mild protests. At last!

We chattered at each on the way back to Toledo, past the familiar sights. Our neighbor Tim was working in his backyard; he came over to the fence to say hi and started talking with us. After a couple of minutes, Kenneth got impatient and came out the backdoor to greet me. I said, “It’s your long lost Dad, returned at last!”

Kenneth and I rested until Brendan and Mayumi arrived from Cleveland; then we all went out to our favorite Chinese Restaurant, Jing Chuan, for a belated celebration of my birthday. I had a mild headache from sleep deprivation & a really bad case of jet lag, but I was home and with my family, and I was happy.

Saturday, June 16, 2007

My Self-Appraisal: 2007

Entry for 16 June 2007:

Last week in supervision, I rashly promised my students that I would present my self-appraisal this week at our last supervision session. After all, the culminating process on Strathclyde's Person-Centred Counselling Postgraduate Diploma course is the student's self-appraisal, and last week I learned that some of the other tutors present their self-appraisal in the last supervision session. Unfortunately, with my immersion in various things, including my SPR preparations, I forgot until right before the supervision session was set to start. As a result, I winged it in a rather disorganized fashion.

However, the idea of tutors/teachers also engaging in the something like the process we ask our student to do seems to me to be fundamentally sound. So, I decided I should take the idea seriously if belatedly and do a proper self-appraisal.

The first question is: What am I appraising? If I were to appraise my development as a therapist over the past year, I wouldn’t have much to say, because I haven’t seen a client since last June. I have treated the past year as I did my two foreign sabbaticals (England & Canada), during which I took a sabbatical from doing therapy also. In retrospect, this was useful, and kept me from burning out as a therapist. Now, however, it is time for me to get back to seeing clients, and I am looking forward to doing so in a few weeks, when we start seeing clients through the research clinic.

But what I am really interested in appraising is my work as a therapy/counselling trainer, since that’s much of what I’ve been doing since I arrived last September, and also that is what is most relevant to the Diploma course. So: What are my current strengths and weaknesses as a trainer? How have I progressed? What do I need to work on in order to be a better trainer?

My Strengths as a Trainer:

1. It is great to be able to draw on years of experience with clients and students, without being cynical or jaded, or too full of myself. When it comes to training, I’ve been thinking about training issues for a long time, and quite systematically for more than 10 years.
2. I genuinely like my students, and take pleasure their varied life experiences and interests.
3. I’ve found that gentle, often self-deprecating humor goes a long way toward helping students learn productively within their vulnerability. It also helps that I am genuinely enjoying what I do here!
4. What it comes down to for me is that I love the training process and find myself drawn to it as a way of giving myself.

My Weaknesses as a Trainer:
1. I consistently try to put too much into my presentations. While it is true that I fear boring people by dwelling on the obvious, I often err in the other direction, leaving my audience behind (which is boring for them also!). I’ve tried to follow the discipline – which I’ve seen most clearly in John McLeod’s presentations -- of presenting only as much information as I can get onto 2 sides of an A4 sheet. But I have found this quite difficult. There is some obsessive, show-offy bit in me that wants to keep squeezing more material in.
2. I have overloaded myself with so much activity here that it is difficult to balance everything. At times, this affects the quality of my presentations and other training work, as when I don’t allow myself enough time to prepare adequately or when I come in tired because I didn’t allow myself enough sleep.
3. I am aware of the importance of live, experiential elements in my presentations, but don’t always follow my own advice. For example, I played almost no video examples for the EFT-2 training, and my research inputs for the Diploma course were at times drier than they needed to be.
4. I feel somewhat insecure about my expertise as a therapist, which has made running the EFT Level 2 training this past year challenging for me, given that most of the therapists are highly experienced. I kept wondering, what do I have to offer these interested, talented people?

Progress this Year (also more weaknesses...):
1. I am far more at home with what I am doing on the diploma course. When I arrived, most of the training practices were strange to me. Not totally alien, but consistently off from what I was used to. And most of the things that I thought I recognized turned out to not be the same either, which heightened my confusion. Now at least I am somewhat oriented. Now I am looking forward to the coming year to see about all the things that were so weird that I didn’t even notice them this year!

2. I did read a fair amount of the documentation on the Diploma course before I arrived, but I found it abstract, and difficult to relate to and retain. As a result, I didn’t feel particularly engaged and a lot of things went past me: I missed meetings whose significance wasn’t clear to me. I was gone for a week of the intensive part of the training. I got mixed up about the times and didn't show up for a supervision meeting (I had to be phoned at home and came rushing, very embarrassed a half hour late). I was late getting student papers graded. I assumed that I would switch supervisees each term, until that didn’t happen. Most comically, it took me 4 months to realize that I wasn’t my students’ only supervisor, and I didn’t know there were three terms or a spring break/Easter holiday until these things happened to me!

Whenever one of these things happened, there was some disorganization that followed, and as a result, I learned what is important here. This was difficult for all involved, but it gradually grounded me in the important aspects of the Diploma course. This is some version of the truth that we learn more from our mistakes than from our successes!

3. The students here are different enough from those that I was used to working with in the USA that it has taken me a while to get a sense of them. Few of them have backgrounds in psychology, and most are not particularly interested in research; they're not even socialized to pretend that they are interested in research! They remind me more of the older, nontraditional graduate students that we used to get at the University of Toledo 20 years ago. They are a wildly varied bunch, actually, in terms of the academic and personal backgrounds, which has been a challenge for me, because it’s harder to figure out how to gear my presentations. My standard strategy of offering dense, challenging presentations, which has served me well for so long, often falls flat in this context, requiring me to be more flexible as a teacher. I have made some headway in this direction, but I see now that I will need to continue to be creative in what and how I teach.

4. Although I still occasionally get carried away with myself, I have learned how to find a balance between being able to draw on my own experience and giving my supervisees space to use their own developing therapeutic wisdom. It is a real pleasure to see this wisdom emerging in them; I love to listen to them helping each other!

5. In the EFT-2 training, by the end of the course I had finally arrived at the point where I felt comfortable with what I have to offer. While it would have been nice to have started at that point, it felt very nice to have reached this sense of really having something useful to offer, and it gives me a really good base on which to build for next year.

6. I am becoming much more comfortable with unstructured large groups, including Weird Sh*t processes, especially anger expression in group contexts. At my last job, such processes became extremely toxic, and over the past couple of years I have developed a mild phobia of them. I believe that I am now regaining my ability to hold such processes productively. (Incidentally, WS has now been picked up by this year's fulltime diploma students and become part of the culture.)

My Goals for the Next Year:
1. Start seeing clients in our research clinic protocols.
2. Organize all my diploma presentations with video examples or experiential work.
3. Learn more about large group processes.
4. Start making serious proposals for helping the diploma course continue to evolve.
5. Make sure that I continue to enjoy myself!

Yesterday, at the large Large Group of the Full Time Diploma course, I was asked if I felt ready to take the diploma. For me, this translates to, Do I now feel reasonably competent to facilitate my students’ learning in this new context. In retrospect, I see that in many ways I was not completely competent to do this over the past year. Fortunately, I was able to get by with a lot of help from my friends on the course team and elsewhere in the Counselling Unit. However, I now feel ready to function effectively as a trainer here, so yes, in fact, I do feel ready to “take the diploma”!

Sunday, June 10, 2007

Response to Large Group Blog Entry

Entry for 10 June 2007:

Carmen, one of the students on this years’ Full Time Conselling Diploma course has sent the following response to my earlier comments on the Large Group (entry for June 2). With her permission, I am pleased to post her comments, which I personally find very interesting and useful in carrying the discussion further:

As a person at the end of the course you are describing I am perhaps in a position to offer what I feel I have learnt from the big group sessions.

Big groups can be fun, interesting, uncomfortable and scary. The fear is of the anger, judgement or retaliation of others. If a person is able to be non-defensive and reflective then there is the opportunity to learn, trust and balance what is inside alongside the views of others. An issue with the big group is the 'if', because not all people are at this stage. I suspect that the big group is more scary for these people. I guess there is a hope that by the end of the course some progress might be made toward this stage.

Personally I have learnt a lot from my reactions to the 'WS' of the big group. I have been unable to ignore my reactions, I have started to listen to my head and feelings reactions, I have started to be able to respond in these situations in an 'appropriate' way. I have learnt that however much I safely prepare what I say, it can still have an unpredictable effect on others. I cannot control the reactions of others but I can own and articulate my own reaction.

I have learnt that sometimes 'WS' cannot be contained, even by experienced tutors. Sometimes things just happen too quickly. Tutors are human, not super-human. Sometimes things do go off the wall but the hope is that we can use the underlying relationships, trust, care and empathy to move and grow from this. Sometimes the group has managed to do this by itself. However, I do feel it would be helpful to have at least one consistent big group tutor who has a role to facilitate this aspect when the group doesn't manage it. This would be a real judgement call for that tutor, to know when to allow enough time for the group to find its process, and when to intervene. I suspect this is a modelling role, important in the initial stages of the course and gradually seeing the group take it over?

I strongly believe that what I have learnt from the big group is invaluable in a counselling context. In particular, being able to openly respond to clients whatever they bring. What the big groups (alongside the personal and professional development group) have helped me to increasingly develop and experiment with is congruence. For me the big groups have felt an essential part of this development.

I don't yet feel able to comment on the self appraisal process as I am way too in the midst of it to be objectively reflective. What I can say is that it I have found it to be a strongly insightful process.

Friday, June 08, 2007

Counselling Psychology Professional Doctorate Program Given the Greenlight

Entry for 8 June 2007:

For the past year, Ewan Gillon, at Glasgow Caledonian University, and Mick Cooper, at Strathclyde, have been putting together a doctoral course in Counselling Psychology. After I arrived last August, I was soon plugged into this process and have been going to meetings with Ewan, Mick and various other folks from GCU and Strathclyde (including Elke). We have spent many hours arguing the overall design of the course and the specific courses (“modules”) within it. I wrote the two research course modules and have made suggestions for the therapy modules in particular. It’s really Ewan’s baby, and Mick and I have often felt guilty that we weren’t able to do more to help Ewan. One of the trickiest bits has been trying to balance and integrate the multiple competing demands of the two collaborating universities with each other and with the requirements of the British Psychological Society. In particular, the BPS requirements appeared to be at odds with the existing models of research doctorates. BPS wants practice-oriented, professional training courses; the two universities are still wedded to the idea of apprentice-model professional doctorates focused predominantly on research.

What is exciting about the proposed course is that (a) it will be the first Counselling Psychology course in Scotland; (b) it will be the first Counselling Psychology course with a Person-Centred/Experiential approach as its basic model; (c) it offers real possibilities for integrating research and practice the kind of creative, innovative ways that I have been advocating for years.

Today, after all this preparation, the “Validation Event” for the proposed course occurred. The panel doing the evaluation consisted of a mixture of faculty from GCU (the largest representation), Strathclyde (1 person), and two external members (one of whom was John McLeod, the other an entertaining, experienced counselling psychologist from City University in London, Jacqui Farrants). Mick, Cynthia (a faculty member fro GCU) and I had dinner with the panel members last night. Ewan had been out sick with the flu for most of the week, presumably at least in part from the exhaustion of organizing this thing, so he didn’t come the dinner.

The event today was not without some drama: Would Ewan manage to get up out of his sick bed? And if he did, would he be able to speak in coherent sentences? Would the committee trash the course? Mick picked up indications that Ewan was framing the course incorrectly, which could have led to big problems, so last minute meetings took place hurriedly before we started this morning. The associate dean provided very helpful orienting information, which in my case was a very good thing, because I had no idea what to expect, aside from assuming that the process would not be entirely unlike an APA Accreditation Site Visit. And we were off.

The committee asked good, penetrating questions, beginning with the most important issue: What sort of program is this? This is of course what we had spent months arguing back and forth with each other. After much discussion, the committee steered us to an expanded Professional Doctorate-model program, which was much clearer than the waffled hybrid model we had been working with. In retrospect, it is clear that this is the tack that we should have been pursuing from the beginning, but we hadn’t really realized it was an option. We had understood the Professional Doctorate to be an apprentice-model research degree without significant taught components. Now we were given to understand that a better frame was an expanded Professional Doctorate degree with some taught elements (i.e., enough to satisfy BPS). Apparently, this is the magic formula for making the various adminstrations at both universities happy!

The rest of the morning was spent in a very high-level discussion of specific issues, in particular, of flow of students through different stages of the program and of the methods for evaluating student program. We found this discussion to be very valuable in helping us to progress our thinking to the next stage of the program development process.

Afterward, while the panel met with University administrators and deliberated, Ewan, Elke, Mick and I went to the staff refectory, where we decompressed and laid out the process for interviewing prospective students (not a moment too soon; the interviews start next week!). As is his wont, Mick tried to get Elke and me to go off and not stay for the feedback session, but we hung around long enough that it became silly not to stay. I knew from personal experience of APA site visits that this sort of feedback session can be extremely interesting and of course provides a sense of closure for the whole process.

In the end, of course, this turned out to be the case: The committee had in relatively little time produced a very clear, well-organized set of requirements and recommendations. They made various sensible suggestions. And they also commended us for our work and the quality of the course development team and for the enthusiasm and commitment we showed in our presentations today. We left in a good mood and with a large sense of accomplishment, tired but excited. There is still a lot of work to be done in order to put this course on the tracks for this coming academic year, but it is finally something that can be imagined and lived into in a very real way.

Updated Announcement: Emotion-Focused Therapy for Depression Summer Reading Group

Entry for 8 June 2007: [This entry has added details not in the previous version]

This Summer, I will lead a 5 – session informal reading group on Emotion-Focused Therapy for Depression. Attendance is open to counsellors and postgraduate counselling students with at least some training and familiarity with Process-Experiential or Emotion-Focused Therapy (at least 2 days of lecture/workshop training). We will work our way through Greenberg & Watson’s recent book, Emotion-Focused Therapy for Depression (APA, 2006), and will also view and discuss illustrative recordings of PE-EFT sessions.

Format: Sessions will be two hours, Wednesdays 18:00 to 20:00 on the Jordanhill Campus of the University of Strathclyde (room W312). The first hour will be book discussion; the second hour will focus on looking at session recordings (e.g., a DVD of Les Greenberg doing a two-session therapy with a depressed client).

These sessions are free, but participants are expected to buy the Greenberg & Watson book, and to keep up with the reading (60 - 80 pages per session) and to come with questions and observations. This is not a skill training and no CPD credit will be given. The schedule of Reading Group meetings will be:
27 June: Greenberg & Watson: Chapters 1- 3; EFT for Depression/Greenberg video: session 1
18 July: GW: Chapters 4 – 6; EFT/D video: session 2
1 Aug: GW: Chapters 7 – 9; EFT/D video: commentary
29 Aug: GW: Chapters 10 – 12; Toledo Depression Project archival video
12 Sept: GW: Chapters 13 & 14; Toledo Depression Project archival video

If you are interested in participating, please contact me at

Saturday, June 02, 2007

Talking with Dave: Self-Appraisal and Large Groups

Entry for 2 June, 2007:

After dinner on Friday, Bill headed back to his hotel and Peter, who had had only two hours of sleep the previous night, soon retired to bed, leaving Dave and I on our own to talk for a couple hours. It was one of those memorable, wide ranging conversations, and this time, as he talked about his experiences teaching at Strathclyde, I had the proper context to appreciate much more fully what he had to say. I have been at Strathclyde for almost a year now, including the month I spent in Scotland last summer before we moved, and I will take over as Chair of the Counselling Unit Management Team in August. So it was very helpful and timely for me to be able to pick his brain on various important matters.

Self-appraisal. In particular, we discussed my reservations about the self-appraisal process in the Diploma Course, its philosophy, context and implementation. Self appraisal in education (i.e., allowing students to evaluate their performance and, ultimately, to decide whether they should pass or fail) is a fascinating, complex and controversial topic. Dave believes that self-appraisal was his most successful educational innovation, and argued that unless one gives students power to decide whether to take the diploma or not, all other attempts to share power are meaningless. He further argued that in terms of quality control, more students “unfit to practice” slip through on tutor-assessed courses than with self-appraisal, because the student him- or herself understands their context and abilities more fully than it possible for teaching staff. From his point view, allowing a few unfit students to “slip through” is necessary in order for self-appraisal to be truly effective.

Large Groups. Another thing that I have found quite puzzling is the function of the large groups, in which all 30-odd students spend about 90 minutes/week in a large unstructured group. I have been questioning staff about these groups for a year, without really getting a satisfactory explanation. Often, it comes down to “that’s what we did in my training”, which has always struck me as about as meaningful as saying, “that’s what we did in my family.” This year, we had Beth do an input on the function and uses of large groups for the students, but roughly half of the students I talked to in the consultation process still found the large group process to be meaningless, unhelpful or even potentially harmful. I have also noticed PTSD-type reactions from former students when they enter the room in which the large groups took place during their training.

According to Dave, the purpose of large groups is to put students in a situation in which they can’t fall back on their standard roles or ways of self-presentation; this is supposed to enable them to access aspects of themselves that they wouldn’t ordinarily be able to, which helps them to be able to work effectively with a wider range of clients. So basically, what this comes down to is that large groups create a chaotic situation in which Weird Sh*t (=WS) routinely happens. Students learn how to deal with WS by dealing with WS in large group.

Now, this makes some sense, but I am left with at two questions:

First: Aren’t there other, less chaotic, more focused ways of helping students learn to deal with WS? For example, closely supervised clinical work with diverse clients; experiential work with difficult therapy situations; and viewing recorded examples.

Second: Isn’t it possible to do harm if the WS is not properly managed? This is certainly what appears to be what many students are reporting can happen in large groups. It seems to be the case that it takes a great deal of trainer skill to active facilitate successful resolution of WS processes in large groups. It is one thing to be nondirective when working one-on-one with clients, for there the therapist’s power is much more manifest and problems of client deference are more likely. However, as soon as we start dealing with couples, families or larger groups of people, it seems to me that relational or group dynamics take hold, making it essential for the facilitator to respond actively in a strongly process-guiding way to help the process move forward to a successful resolution. Otherwise, the usual, often destructive patterns, just run their often-circular course, often leaving emotionally injured students in their wake. It further seems to me that being able to hold such processes is likely to be the most difficult teaching activity that teaching staff in a person-centred therapy course are called upon to do. As Dave finally said, if facilitators can’t successfully hold this process, then there shouldn’t be large groups.

I found this discussion to be very useful for helping me think about these and other issues. I have resolved to try to get together with Dave from time to time for further background discussions!

PCEP Journal Editors’ Meeting

Entry for 2 June 2007:

Saturday Morning I got up, late, and ran along the Thames: Over the Millenium Bridge flooded with people walking to work (and a few runners); to the Tate Modern Art Gallery; then along the South Bank past the County Halls Museum, with its large Dali Statues next to the river; beneath the Millenium Wheel, which I’d last seen collecting energy for an alien monster on Dr. Who; across the Westminster Bridge; and then back along the north side of the river, past the floating restaurants and excursion boats, their gangways tipping down at low tide.

Peter F. Schmid and Bill Stiles arrived about ten, and Dave Mearns went out to the Marks & Spencer to buy provisions for the journal editors meeting. We visited a bit, but mostly took advantage of someone’s open wireless network to check our email. Once Dave returned we started our meeting; as usual, we had a long agenda to cover over the next 24 hours.

Person-Centred and Experiential Psychotherapies, we remarked, is doing well: We are in a much better position than last year in terms of papers in the pipeline and special issues, and were able to lay out most of the next year. The journal feels solid, and we seem to have fallen into a rhythm with the work and now know each other pretty well, which helps us organize tasks such as recruiting more submissions. Over the course of the day, several emerging changes came into view: For me, the most exciting of these was presented by our Noble Publisher, Pete Sanders of PCCS Books, who laid out the possibility of buying into a package that would allow on-line submission and journal office automation and at the same time make it possible for current subscribers to log on and get access to all current and previous issues. This would require increasing journal costs by 10-15%, but that would be the first increase in the journal's history. Bill is a believer in the “information wants to be free” philosophy, so he is hoping to be able at some point to persuade the World Association board to make all articles published 12 months or more available to everyone for free. We shall see.

After this, Pete took us out the dinner at the Tate Modern restaurant, which commands a spectacular view over a large part of central London. From this height, we counted a flock of 25 building cranes scattered around and behind St. Paul’s Cathedral, proof of the large number of new buildings rising in London’s main business district. At this point, in the early 21st century, there is a lot of money sloshing around London, much of connected to the banking industry. We talked about politics, primarily Scottish and American, diagnosis and organized psychiatry, and had just reached philosophy of science issues when Pete decided he needed to head out. It was a case of philosophicus interruptus.

One of the developments of the day’s meeting was an agreement by my fellow editors to recommend to the World Association Board that I be designated Editor Emeritus, with a continuing portfolio of overseeing progress toward journal indexing and other such tasks as might be required. This would allow me to step back from the journal while still maintaining some level of helpful involvement. My stepping back into this role will make space for Jeanne Watson, who begins as co-editor on July 1. Welcome Jeanne!

Friday, June 01, 2007

Trip to London on My Birthday

Entry for 31 May 2007:

Today is my 57th birthday. I got up this morning, stuffed the Complete Song of Robert Burns 13(!)-CD box set that Diane gave me for my birthday into my backpack, and took me and my suitcase off to the Hyndland train station so I could catch the 9:39 Virgin Express train to London Euston. It was a lovely sunny day, about 60F (15C) already at quarter to 9 in the morning.

As we travelled south, first through southern Scotland, then through the Lake District south of Carlisle, I marvelled at the intense green of the fields, dotted with sheep, this year's lambs growing up already but still playful. I’d been up late last night doing email & packing, so it took me most of the way to Carlisle to write up the dream in the previous entry, as I was also listening to the first volume of the Burns Songs set, which consists of lovely, simple folk settings, some familiar, some not.

I started work on a manuscript for the German-language person-centred therapy journal Person, which I had realized last night was technically due today. I will be seeing Peter Schmidt tomorrow, and it was he who asked me to write the article, so I thought I’d better at least make a start. I seem to live always at the edge – or just over the edge – of one deadline after another. “Because I would not stop for Death, he kindly stopped for me”, wrote Emily Dickinson, the great but eccentric 19th American poet. After awhile I turned my attention reviewing a promising but as it turned out ultimately disappointing manuscript for J of Consulting & Clinical Psychology, dozing from time to time as we sped south toward London.

It felt like 70F degrees in London (it was at least 20C), with a light breeze, as I walked from Euston Station to Regents Park. The Park was full of people, especially families with small and children, enjoying the beautiful weather. I managed to locate Regents College (where Mick Cooper did his training in existential therapy, I’m told), and the book launch event that Dave Mearns had invited me to. Dave and Brian Thorne had persuaded their publisher, Sage, to sponsor a free continuing education session for Person-centred trainers, complete with free books, muffins and wine. I had a fun time hanging out with this crowd, watching Dave and Brian position themselves in their answers to the participants’ sometimes challenging questions. After the question & answer session, I stood around and talked to different groups of people for quite a while, discussing research, life in the UK. A truly enjoyable way to spend a birthday afternoon!

Brian, Dave and I took the Tube (London Underground) back, so I got good use out of the Oyster Card that Chris & Nancy talked me into buying last October. (This is a money card for riding on the London Underground and bus system.) Dave and I hung out for a bit at the place we’re staying near the Millenium Bridge, to went to meet Brian, Bill & Sue at an Italian restaurant near Oxford Circus. Brian has been eating at this same restaurant for 50 years; when he first started eating here, the present owner’s grandfather was running the place! It turned out to be an entertaining, relaxing meal, after which we all staggered off to our respective places.

Finally, back at the flat, Diane and Brendan phoned to wish me a happy birthday. One of the ways we celebrate birthdays in my family is to analyze the number of one’s years. Hmm… 57 = 3 X 19 = the product of two primes, or as Brendan pointed out, the legendary number of the Heinz company’s varieties. All in all, a lovely day learning things and hanging out with friends while we worked, at a leisurely pace, getting ourselves geared up for tomorrow’s long Journal meeting

P.S: I mustn’t forget the Badgers, who would be offended to left out, since they have decided to share a room with me here at the flat. Dave reported that they had a nasty shock on the way to the airport this morning: they passed a dead baby badger along the side of the road, and were badly shaken by this. They insisted on hanging out with me, so they helped me fetch the track labels for the Burns CDs and encode the first 6. They have been sitting on my silver Pukka Pad all evening, which is a place of Great Honor, so I hope they appreciate it. While they are not as cute as Diane, they do have very nice black and white fur and I certainly appreciate the company.

Dream: A Cutting Remark

Entry for 31 May 2007:

Dream: I am at an event for a politician, I think it is Michael Dukakis (unsuccessful US Presidential candidate from the 1980’s). There is some kind of dialogue among a group of us. He says something reasonably clever, but I immediately come back with something much more clever, which is also a nasty put-down. There is moment of astonished silence, as if no one can believe that I have said this. I had expected him to give back as good as I gave, but suddenly he seems to deflate, wounded by what I’ve said. In the moment I spoke I felt a kind of spiteful power, but now I just feel bad. I try to do his job for him, explaining that I am from California, where we have no manners and are uncivilized, uncouth creatures, who sometimes say things that are offensive to people from Massachusetts and the East. But this, too, falls flat, and I am aware that everyone is looking at me. I feel intensely embarrassed and disturbed at my behavior.

Emotion scheme analysis:
I. Emotion scheme nucleus (felt emotion): Spiteful power/glee, changing to troubled embarassment (see end of analysis for more)

II. Perceptual-memory elements (also: intentionality; associations):
-Sensations: I’m aware of the room, with small desks like a classroom and people sitting in them; the politician, the suit he is wearing, the look of shock on his face after I have spoken, the way he seems to deflate; then I feel the eyes of the others there boring into me.
-Current life situation: I am under a lot of pressure, with an overwhelming amount of work to do. Last night I found myself getting more and more cranky as I worked through yet another pile of accumulated email. I had to hold myself back from writing a snotty email to the person organizing my University Ethics Submission who thought there was a problem with the fact that one of my appendices contained a 1999 research manual that listed me as being at the University of Toledo. I was cranky and short with Mick over proposed changes in the MSc course. Elke and I had an email exchange in which she expressed what I took to be annoyance with how I had handled something and I expressed frustration with the situation, again holding myself back from being cranky; at one point I almost literally had to bite my tongue to keep myself from going around the same frustrated circle again. I had an image of us each sitting up late, our partners elsewhere or busy (Diane is in America; Dave I assumed [incorrectly it turned out!] had gone done to London for an event today), struggling with the load of lonely, unceasing work.
-Associations/references: Other times when I had gotten myself in trouble for speaking impulsively and hurtfully to others, from childhood to my previous job. Why Michael Dukakis? I don’t know; maybe remembering the presidential debates he was in, how he seemed a combination of assertive and vulnerable; today I have the impression that he is seen as smart but ineffectual.
III. Bodily/expressive elements:
-Likely facial expression: I picture a smug smile on my face as I speak, then eyes wide with surprise at the reaction to what I’ve said, turning to a frown.
-Bodily sensations: A feeling of power and energy; then a sinking in my stomach, a kind of sick feeling.
IV. Cognitive/symbolic elements (e.g., metaphors, propositions, identities)
-Propositions: I’m a spiteful, abusive person who doesn’t care about others. My anger is dangerous to others and must be controlled.
-Metaphors: Vicious beast; words as weapons
-Identity: Negative identity; dreaded self: abuser
V. Action tendency/wish (also lessons, directions for action):
-BodilyAction/Action tendency: Express my self, show off, show that I am up for verbal sparring; then, defend myself from others’ judgment of me; finally, just hide, be invisible
-Wish/fear: Wish: To be admired vs. fear: to be judged negatively. Wish: escape negative judgment vs. fear: trapped.
-Lessons: Something is out of balance in my life at the moment, and needs attention or else others and I will be hurt.
VI: Further understanding of primary emotions as result of preceding exploration: Fear of losing caring, supportive relationships around me, being rejected/excluded (this is an old, i.e., primary maladaptie emotion response). Emotion response sequence: Fear that I can’t keep up leads to showing off, disdain, judging/putting others down, which leads to feeling guilty, rejected etc.