Tuesday, October 30, 2007

If I Ran the Zoo: A Modest Proposal for Training the Trainers

Entry for 29 October 2007:

I. Context. I’ve been to London to a Training the Trainers meeting on a grant obtained by Sue Wheeler (U Leicester) and Nancy Rowland (BACP). After several years of trying, they managed to get funding from ESRC (Economic and Social Research Council) under a grant program entitled Researcher Development Initiative (RDI). They managed to rope John McLeod and I into this, and so we came along today for a stimulating discussion at the University Women’s Club in central London. (This is club that women at any university in the UK can join, and an inexpensive, welcoming environment, including accommodation and meeting space, in the centre of London. The overall impression is pleasant, rather quaint and slightly shabby-genteel.)

I agreed to be part of this because I have strong feelings about research training and am continuing to develop my thinking on the topic in what I see as creative directions. Throughout the day today I was aware of a real danger that we would slip into familiar, stock ways of thinking about research training, ways that could potentially “kill the spirit”, and ultimately prove to be self-defeating.

I began this morning with a plea for an experiential approach to research training. This was listened to, apparently appreciated… and assimilated into an “immersion” process to be tacked onto the front of a week-long short course in a form what threatened to be a traditionally-structured curriculum. At the end of the day, sensing my disquiet, Nancy turned to me and asked me, “Robert, if it were entirely up to you how to organize this, how would you do it?” I paused, and then began, quoting Theodore Geisel (known to millions of American children as Dr. Seuss), “If I ran the zoo…” and I went on, “I would start by identifying a set of research activities that students are likely to find highly relevant to their practice, and then help the trainers learn how to help their students learn how to carry these out.”

The following is an elaboration of the rest of my reply:

II. Working Assumptions. First, based on 30 years of teaching research methods to undergraduate and postgraduate students, I start from the assumption that there are two kinds of counselling folks (i.e., counsellors/therapists and counsellors/therapists-in-training):

Group A. Most counselling folks are not that interested in research. (This is understandable, given their background and motivation for studying counselling.) Forcing them to do research, or subjecting them to lectures that they experience as dry and unrelated to practice is counter-productive and may lead to resentment and increased antipathy to research, that is to say, it can do more harm than good. For these folks, research training needs to be experientially-based and to emphasize relevance to practice. This training can introduce them to research and show them that it can be useful and interesting, helping them deepen their appreciation for and interest in research, in some cases helping them moving from Group A to Group B.

Group B. Some counselling folks are naturally interested in research and will benefit from research training that includes learning about philosophy of science issues and a range of formal research methods -- as long as it is done in an interesting, open way that doesn’t kill their native interest.

Right now, as far as I can tell Group A corresponds to the great majority of students in postgraduate diploma courses in counselling, such as the one at U of Strathclyde, while Group B corresponds to our MSc Counselling students. Clinical psychology postgraduate students are actually not that different, but they are socialized to pretend they are in Group B, when actually most of them are in Group A. I suspect that the students in the new Counselling Psychology Doctorate course are like this also, a mixture of Groups A & B. My preference would be to start them off with a Group A-type approach, and then help them move on to Group B.

For Group A, I feel that training would best be focused around a set of research-related tasks that can be directly grounded in their practice as counsellors:

III. Research Tasks that are Counsellors are likely to Find Useful in Practice:

1. Evaluating whether therapy brought about change for a particular client. At the centre of the enterprise of counselling is the dual question of (a) whether a client experiences change over the course of counselling, and (b) whether counselling is responsible this change. While this is the issue that drives therapy outcome research and randomized clinical trials (RCTs), in actual practice it is addressed one client at a time, at the single case level. Thus, students should be able to come out of training having learned how to carry out systematic single case studies that can answer this double question, using Pragmatic or Hermeneutic Single Case Designs. As I have written in various articles, such designs require learning how to use both quantitative and qualitative data collection methods, and to use systematic reasoning strategies to come up with reasonable answers.

I have found that the best way to teach these designs is to carry one out on a client of one’s own, so in working with the trainers I would show them one of my cases, including video clips and qualitative and quantitative data. I would then help the trainers develop a single case research protocol that they could use with one of their own clients, so that they could offer the same thing to their own students.

2. Locating something in the literature that’s useful for working with a particular client. I would next ask the trainers to think of a difficult situation or issue with one of their current clients. I would talk to them about resources for locating literature (both research and clinical) relevant to therapeutic difficulties. As a result, they would learn how to help their students access scientific information. (This would require a training site with internet/library access for the students, perhaps broken up into pairs.)

3. Being able to draw on the relevant research evidence in order to meet challenges to their practice. The next task is probably best carried out with groups of trainers with a similar theoretical orientation. I would ask the trainers to talk about situations in which their approach to practice has been challenged as ineffective by managers, bosses, doctors, the government etc. I would then take them through the research evidence that supports their practice, for example Person-Centred/Experiential, explaining the methods used in the research, including meta-analytic techniques, with the whole idea being that this is arming them to use evidence as a weapon for dealing with challenges. I would want to make sure that they understood and owned these data well enough to be able to convincingly explain them to their students.

4. Evaluating needs or outcomes for one’s agency. After this, I would ask the trainers to think of an agency that they work for or have worked for, and to imagine what kind of information might be useful to help that agency carry out its mission more effectively. What kinds of problems is this agency running into in carrying out its mission? Would it help the agency to have a better idea about what its clientele wanted or needed? Is there a problem with waiting lists, or no shows, or ? Is the agency being challenged to demonstrate its effectiveness? Or would it find it useful to know which kinds of clients were being helped… or not helped? Identifying such problems would then provide a basis for talking about service evaluation activities, that is, simple group design surveys and outcome studies, either qualitative or quantitative, and how one should start with evaluation questions, and then find methods appropriate for answering those questions.

5. Identifying one’s own native curiosity about counselling/psychotherapy practice, and developing this into do-able research questions. Lastly, to provide a basis for encouraging students to move from these basic applied research tasks to more challenging, larger scale research, I would take the trainers through a Focusing exercise, to help them look inside in order to identify one or more topics that capture their curiosity. I would also offer them a list of key current research topics (“fronts”) appropriate to their theoretical orientation, and ask them to check these against their curiosity, to see which if any resonated with their curiosity. This would lead into issues of research supervision, helping students develop clear, answerable research questions, and helping them select research methods appropriate to answering those research questions.

And that’s what I would do if I ran zoo! (… said young Gerald McGrew.)

Another New Publication: Elliott & Freire (2007)

Entry for Oct 29 2007:

Gene Gendlin founded Psychotherapy: Theory, Research, Practice & Training, the house journal of the Division of Psychotherapy of the American Psychological Association. Since then it has had its ups and down, but recently it has been flourishing under the editorship of Charlie Gelso, a colleague of Clara Hill's at the University of Maryland. Last year, Charlie asked me to write a short piece for a special section of the journal marking the 50th anniversary of the publication of Carl Rogers’ famous paper on the facilitative conditions. I wrote back to Charlie asking if there were any classical person-centred folks writing commentary pieces. The answer was no. Because this offended my sense of fairness, I invited my classical colleague Beth Freire to co-author the piece with me, with each of us presenting our own view of Rogers (1957) in a kind of dialogue. Charlie got a “twofer”, and Beth and I got the experience of collaborating on the paper, which turned out to be a very nice experience. As with Elliott & Greenberg (2007), the hardest part turned out to be working within the page limit, but we managed, and were very pleased with the result, cited below with the abstract.

Elliott, R., & Freire, E. (2007). Classical Person-Centered and Experiential Perspectives on Rogers (1957). Psychotherapy, 3, 285-288.

Abstract. Rogers (1957) foreshadows the later development of the person-centered approach in North America and elsewhere. In this paper, we present contrasting perspectives on the legacy of this key paper: First, from the perspective of classical person-centered therapy, Freire describes the context for this key paper within the wider frame of Rogers’ body of work and emphasizes its continuing importance and relevance. Second, Elliott offers a personal history from the point of view of a psychotherapy researcher and process-experiential therapist. These two perspectives represent two major and distinct views of Rogers’ legacy from within his direct intellectual and therapeutic descendents.

New Publication: Elliott & Greenberg (2007)

Entry for 29 October 2007:

A couple of years ago, Al Mahrer approached me about contributing an article on my and Les’ approach to therapy for a special section on Experiential Psychotherapy for the American Journal of Psychotherapy. In due course, the deadline approached and the article was rewritten, submitted, revised etc. Last week I got my copy of the issue with this article in it.

In this article, I tried to communicate the basic ideas of Process-Experiential/ Emotion-Focused Therapy (PE-EFT) as clearly and simply as possible, which at times felt a bit like writing haiku, trying to communicate richness and depth in simplicity. I’m not sure how well we succeeded but I think it was worth a try, anyway. And besides, I had always thought it would be cool to publish something in this particular journal, a classic, old-time psychotherapy journal published by the American Academy of Psychotherapists that I have been reading tables of contents, and more recently abstracts, from for many years. It was a fun project, and I hope some people find it useful. Interestingly, in an introductory piece to the special section, Al Mahrer now regrets the use of the term “experiential psychotherapy” and wonders what all the therapies grouped under its umbrella really have in common… At any rate, here is the citation and an abstract for the paper:

Elliott, R., & L.S. Greenberg. (2007). The Essence of Process-Experiential /Emotion-Focused Therapy. American Journal of Psychotherapy, 61, 241-254.

Abstract. Process-Experiential/Emotion-Focused Therapy (PE-EFT; Elliott et al., 2004; Greenberg et al., 1993) is an empirically-supported, neo-humanistic approach that integrates and updates Person-centered, Gestalt and existential therapies. In this article we first present what we see as PE-EFT’s five essential features, namely neo-humanistic values, process-experiential emotion theory, person-centered but process-guiding relational stance, therapist exploratory response style, and marker-guided task strategy. Next, we summarize six treatment principles that guide therapists in carrying out this therapy: achieving empathic attunement, fostering an empathic, caring therapeutic bond, facilitating task collaboration, helping the client process experience appropriately to the task, supporting completion of key client tasks, and fostering client development and empowerment. In general PE-EFT is an approach that seeks to help clients transform contradictions and impasses into wellsprings for growth.

Sunday, October 28, 2007


Entry for 28 October 2007:

A couple of weeks ago, I suddenly developed a weird eye condition commonly called “floaters”: Coming home from a performance at the Star Folk Club on a Thursday night, I suddenly noticed strange threads in the right visual field of my right eye. I initially took these to be cobwebs or long, knotted hairs hanging down from my hat. I kept trying to brush them out of the way, without success. When I described them to Diane, she called them “floaters”, which I then looked up on the internet. Apparently, the vitreous part of my eye has shrunk enough to pull away from my retina; these are bits of crud that result from process. There is also some chance of retinal detachment, which could lead to blindness. When I phoned my GP, I was given an appointment the following week. When I finally got in to see him, he sent straight over to Gartnavel Hospital to have it evaluated. After a couple of hours waiting in the Eye Casualty Department, a nice ophthalmologist ran me through several tests and declared my retina to be undamaged. Maybe they would go away in a couple of months, she said… or maybe not. The floaters are more a nuisance than anything else, distracting me when I’m trying to read. Because they are constantly moving, my visual system is having trouble editing them out of reality, in case they turn out to be real. In the meantime, they are a source of entertainment during long, boring meetings. A surreal experience!

The ScotCon Research Community

Entry to 28 October 2007:

ScotCon, the Scottish Consortium for Psychotherapy and Counselling Research, has several functions, including organizing Scottish SPR meetings, and coordinating research efforts at various Scottish universities. Now we are adding two new functions: a research support group and a series of conferences on single case research methods.

Last Thursday was the first real meeting of the ScotCon Research Community. Mick, whose idea it was to do this, was out of town, so Brian Rodgers and I were caught a bit by surprise, when we were suddenly confronted with a diverse collection of 22 diverse MSc, Counselling Doctorate, and Research PhD students. (We had been expecting the usual 6 – 10 MSc students, and hadn’t really taken on board the idea that most of the other people that Mick had invited would actually show up.) Looking around the full room, my first impulse was to panic: How can we possibly meet the needs of all these different people? Then I took a deep breath, and said, “OK! Welcome to our Research Community! Our goal here is to create a way of working together that will work for us, and meet your research needs.”

We then went around the room, each of us spending a minute or so reporting in on our current state of progress on our research projects. (I was very grateful that Mick had previously negotiated us down from the 5 min each that I had preferred, or we would have been there all night…) There were 9 beginning-level MSc students, working on their ethics proposals; 3 advanced level MSc students, collecting and analyzing their data; 7 first year Counselling Psychology Doctorate students, still bright and bushy-tailed even after a day of classes and anxious about their ethics proposals; two research PhD students; and a sabbatical visiting scholar (Mikio).

We then split up into two groups: About 15 came along to hear what I had to say about research ethics and Strathclyde’s ethics review process, while the rest stayed in the main room with Brian to do a workshop on how to analyze Tiane’s interview data on ethics in the Person-Centred Approach. I guess it was Ethics Night!

Then it was back downstairs again for the Scottish SPR meeting, featuring the Aberdeen Early Trauma research group. At the end of the evening, after a very stimulating presentation from Linda Treliving et al., Brian and I walked back to the train station. We felt exhausted but pleased at how the day had gone. We don’t know how the new Research Community will evolve over the coming months, but it certainly seemed like a good beginning.

Update: Late October

Entry for 28 October 2007:

Clock change last night after Maggi’s Samhain party. Wet, windy night, rain on the windows. This morning, though, the light has come an hour earlier and the sun is shining again. We’ll regret this extra hour tonight, when the sun sets at 10 to five! I’m off on another train journey, this time to London for an initial meeting of the Training the Trainers project. Sunday is not the best time to take the train; in fact, it’s the worst, because they do repair and service work on Sundays. Today I’m going to have to take a bus from Edinburgh to Newcastle. (This time, I looked at air and bus as alternatives, but wasn’t impressed. Nothing beats the 18:08 train out of London Euston: home tomorrow night by 23.30!)

For whatever reason, the train to Edinburgh is pretty full this morning, lots families. Sun slants into the train carriage, then goes behind cloud. Wet streets flash by. Between the towns, the golf courses are full of puddles and Sunday morning golfers.

Progress report:

1. Two articles of mine have come out in the past week: one in American Journal of Psychotherapy, the other in Psychotherapy (I'll do separate entries on these soon).

2. I’ve learned a lot about the NHS Research Ethics process, and the Social Anxiety Study has now been submitted to the local NHS Research Ethics Committee, to be reviewed at their December meeting. I’ve done the application for the Practice-Based Research Protocol, and finally got it sent off to our research office last night for University (re)approval. This additional ethics process has been a real pain, and has cost the Research Clinic a couple of months of prime recruiting time, and me 4 weeks of work that I’d planned to put in on manuscripts. But it’s been necessary and I’ve learned a lot from it, which I can use in supervising students.

3. Things to look forward to: We’ve made our plans for our 3-week Christmas holiday in Ohio and California, visiting our kids and larger families. We are also in the process of setting up the guest bedroom to function also as a study for me. Yesterday we bought an Ikea table. After a couple months of waiting for the new Apple operating system (“Leopard”), I’m finally ready to buy a new home office computer, and will order it this week. Computer will go on new table in re-functioned spare bedroom.

4. Teaching: Successful new class/workshop offerings on Empathy (Monday Part-time course), Narrative Retelling (EFT-2), Psychometrics/Quantitative Questionnaire Design and Research Ethics (MSc Counselling Course).

5. As I have previously noted, the ominous Improving-Access-to-Psychological Therapies (IAPT)-But-Actually-Making-the-World-Safe-for-Complete-Domination-by-CBT movement has come to Scotland. Fortunately, we (the nonCBT approaches and in particular Person-Centred/Experiential therapies) have been offered the opportunity to make our voice heard. After some initial struggle about how to handle differences in the research evidence for Person-Centred and Process-Experiential therapies in the response we are drafting to the NHS Education Scotland’s request for advice on provision of psychological therapies in Scotland, we came up with a satisfactory strategy that everyone seems satisfied with. (Thanks to Mick for taking the lead on this!)

6. Heather, the Counselling Unit’s long-time secretary has left after 20 years at Strathclyde, to work on a big social neuroscience grant project at the U of Glasgow. This is a great opportunity for her, but has left the rest of us somewhat apprehensive about how we will do on her absence, given that she provided a kind of psychological glue to the place. As Tracey noted, Heather has been taking care of all the little bits that no one else was keeping track of. Now the question is, how many little bits are going to get lost in the shuffle? Until we are able to replace her, we will all have to do our best with grace and good humour.

7. November outlook: November is going to be a challenging month, with three presentations on the new meta-analysis, a presentation at the launch of a new research centre, and a short-course on qualitative analysis in Leicester. We would really like to celebrate American Thanksgiving this year, also! We’ll just have to see how this all falls out.

Saturday, October 20, 2007

Clarifying Narrative Retelling for Difficult or Traumatic Experiences

Entry for 18 October 2007:

I didn’t cover the Narrative Retelling Task last year in EFT-2, but thought we should this year, so that was last night’s topic. Narrative Retelling task is particularly relevant to PTSD, which is where we developed our initial formulation in the mid-90’s. Therapy is full of narratives, big and small, and we haven’t always been friendly to them in the person-centred/experiential tradition. Still, over the past 20 years, narrative has emerged as a key framework for looking at therapy, culminating in Angus & McLeod’s (2004) big handbook.

The Narrative Retelling task is an adaptation of Rice’s Systematic Evocative Unfolding, but the marker is a difficult or painful life event, rather than a puzzling personal reaction, which means that process goes forward differently. However, the task had not been systematically studied until Emily Breighner, one of my students from Toledo, took it on for her master’s and now PhD dissertation research. In the process, she has developed a revised task model, updating the one published in Learning Emotion-Focused Therapy.

However, various other tasks are wound up in traumatic difficult life events, and thus need to be sorted out in figuring how best to help clients. Last night, when we practiced the Retelling Task, this became more clear than it had previously. In particular, these related tasks include:
-Unfinished Business (if the main thing is something left unsaid or undone toward an important other),
-Meaning Creation (when a sense of injustice or unfairness is primary), and
-Problem Solving (if the person is right in the middle of dealing with an ongoing difficult or traumatic situation).
All these came up last night in practice sessions, which required the work to go off sideways into the more appropriate task. This means that what people mostly learned was how to stop what you’re doing at a given moment and change to a more important (at that moment) task.

This, however, leaves somewhat open the question of when Retelling is the optimal task. It seems to me that the essence of the Retelling marker is an Emotional Injury of some sort. The Emotional Injury marker has been formulated by Les Greenberg and Sue Johnson in the context of Emotion(ally)-Focused Therapy for couples (EFT-C), where it is a central issue in relational distress. However, emotional injuries also motivate clients to seek individual therapy, and are wound up in a variety of presenting problems, including depression, PTSD and (I now believe) Social Anxiety. Emotional injuries stem from a variety of sources, including physical attacks of injuries (in PTSD), interpersonal betrayal or abandonment (PTSD, loss-based Depression), childhood bullying or humiliation (Social Anxiety). To the extent that the injury is experienced in a context of loss, the person will feel sadness, which will motivate them to seek comfort by telling the story of the injury, and Narrative Retelling will be an appropriate task to offer to the client. This seems to me to be a useful clarification of the Narrative Retelling marker.

One of the issues raised by participants last night was the possibility of reinforcing traumatic experiences, that is, re-traumatizing clients. This is exactly what I believe dissuades many therapists from working directly with their clients’ trauma experiences. The PE-EFT analysis of this issue is that what is needed is for the client to re-experience the trauma but in a different context, thus transforming it. And of course an experience cannot be transformed unless it is first re-activated and experienced in the moment.

The different context explains why Retelling a trauma doesn’t make it worse: Because the retelling involves a controlled re-experiencing in a caring, empathic environment, provides an antidote to the emotional injury: the person experiences their injury being attended to tenderly by a caring other, which is precisely what was missing in the traumatic event. In fact, from an attachment perspective, the most telling injury is the emotional rather than the physical injury. Being genuinely understood and prized in moments of emotional injury is inherently soothing and healing.

Angus, L.E., McLeod, J. (Eds.) (2004). The Handbook of Narrative and Psychotherapy : Practice, Theory and Research. Thousand Oaks, CA: Sage.

Person-Centred/Experiential Therapy for Social Anxiety Study Summary

Entry for 18 October 2007:

The NRES (NHS Research Ethics Service) application asks for a research proposal, including theoretical formulation, which is nice to have as a summary:

Purpose and significance: The main purpose of this research is to validate and improve under-researched Person-Centred/Experiential psychotherapy (PCEP) approaches to Social Anxiety, thus increasing the range of effective treatments that can be offered to these clients. The approaches to be studied are Person-Centred Therapy (also known as nondirective counselling), currently used extensively in NHS primary care settings, and a newer, enhanced version of this therapy, known as Process-Experiential or Emotion-Focused Therapy. Although extensive evidence supports the use of these therapies for depression, neither has previously been studied as a treatment for Social Anxiety, a widespread psychiatric disorder with links to key social problems such as substance misuse and employment difficulties.

Theory of etiology: From the point of view of PCEPs, social anxiety is understood as a result of early experiences of social trauma stemming from shaming by family, other adults, and peers. As a result of these experiences the person develops: (a) a sense of self as incompetent and unacceptable; (b) an understanding of others as setting severe demands that can never be met (“conditions of worth”); and, as a consequence, (c) a strong inner “critic” that continually induces shame in the self; and (d) a emotional avoidance and constriction.

Theory of change: PCEPs address these four sources of social anxiety by (1) offering an empathic, caring, and genuine relationship, which (2) counters the client’s expectations of severe external judgment; this in turn (3) allows the person to begin to discover a sense of self-competence and self-affirmation, which (4) enables them to access and make use of the their full range of emotions. This then provides them with a basis both (5) to counter their inner critic and (6) to initiate assertive action with others in order to meet their needs more effectively.

Recruitment and screening: Clients with symptoms of Social Anxiety will be recruited via University and mental health service user and related websites; by newspaper announcements; by posters and flyers posted in libraries, supermarkets and GP surgeries. (Target sample: n = 20.) Screening will take place in two stages: (1) 20-30 min telephone pre-screening by researcher or team member/postgraduate student; (2) face-to-face structured diagnostic assessment (2 X 2 hr sessions) for DSM-IV Axis I and II mental health disorders, conducted by trained research staff or postgraduate students.

Therapists: Staff and research associates of the Counselling Unit, with credentials in counselling, psychotherapy or clinical psychology; also, advanced postgraduate students in counselling or counselling psychology.

Research design: A standard treatment development design will be used, appropriate to an initial investigation of a psychosocial treatment. The design is a pre-post one-group design (also known as an open clinical trial), with embedded single case design, continuous outcome assessment, and mixed method (quantitative and qualitative) self-report data collection. There will be two partially-overlapping arms within the group design, for exploring variations in the treatment approach, one a nondirective person-centred approach, the other using an enhanced form of person-centred therapy (Process-experiential/Emotion-Focused therapy). For most analyses, data from the two arms will be combined, with only exploratory comparative analyses being carried out (due to statistical power issues). The design allows assessment of outcome; estimates of causal efficacy (at the single case level using systematic case study methods); psychometric evaluation of quantitative measures; and qualitative research on client perceived outcome, helpful factors and significant events. The mixed method design allows use of methods with complementary strengths and weaknesses, thus reducing overall bias. Systematic case studies will use rigorous debiasing methods in the form of careful search for alternative explanations for apparent client change and possible causal effects of therapy.

What clients will be asked to do: (1) Telephone screening interview (20-30 min). (2) Structured diagnostic interviews (2 X 2 hrs): Structured Clinical Interview for DSM-IV (SCID-IV); Personality Disorders Questionnaire-IV; Social Phobia Inventory; Personal Questionnaire Interview; Informed Consent Form. (3) Attend up to 20 therapy sessions of 50 min each, video- and audio-recorded. (4) Before session 1; after session 8; at end of therapy; and at 6- and 18-month follow-up: Complete quantitative outcome measures (CORE-OM, Personal Questionnaire, Social Phobia Inventory, Strathclyde Inventory, Self-Relationship Questionnaire, Inventory of Interpersonal Problems, Helath Utilization Scale; 90 min). (5) After session 8; at end of therapy; and at 6- and 18-month follow-up: semi-structured qualitative interview (the Change Interview; 60 min); Consent to Release Recordings (after session 8 & end of therapy; 10 min). (6) After session 8; at end of therapy: Relational depth scale (20 min). (7) Before each session: Personal Questionnaire (1 min). (8) After each session: Complete brief self-report questionnaires (Helpful Aspects of Therapy Form, Therapeutic Relationship Scale, Working Alliance Inventory; 20 min). (9) After sessions 3, 5, 8: Relational Depth Scale (10 min). (10) Recordings of therapy sessions (for later qualitative and quantitative analyses).

What therapists will be asked to do: After each session: Complete self-report adherence questionnaires appropriate their approach, including process notes (Person-centred: Therapeutic Relationship Scale; Process-Experiential: Therapist Experiential Session Form – 3) (30 min)

Data Archive: The data collected will form a psychotherapy research archive for use over a period of at least 5 years by research team members at the University of Strathclyde. With clients' separate and additional, the data will be stored securely (in the research base in D303B until the move to the John Anderson Campus and after that in a dedicated secure storage room) under the supervision of the chief researcher or his successor. All written data will be anonymized; video/audiorecordings cannot be totally anonymized but will be stored separately and securely. This is a standard procedure in psychotherapy research.

Virgin Train Through the Lake District

Entry for 18 October 2007:

On the 5:55 Train to Birmingham. It’s now 7:30 and we’ve just left Penrith, in the Lake District. I’ve dozed most of the way from Glasgow, having taught EFT-2 until 9pm last night. We had our first frost of the season last night, and we had to scrape the ice off the car so Diane could drive me to Glasgow Central. Venus was high in the east as we drove off through the empty streets. Now the sun is about the rise; the eastern sky is pink above the mists and frosty fields. The English oaks on the hills haven’t lost their leaves yet, though, which is reassuring. I love this part of the journey, through the valleys of the Lake District.

The NRES application for the Social Anxiety study is basically finished; I’ll submit it electronically after I get back from Birmingham tomorrow. The November Research Ethics Committee docket was full when I phoned the local committee (located at Gartnavel Hospitial, a 10 min walk from our flat), so we will have to go with the December meeting. I’m about to start on the Practice-Based Research Protocol, and there is a still stack of manuscripts I need to get to.

But for now it’s off to Birmingham for a meeting of the BACP journal, Counselling and Psychotherapy Research, and it feels like a bit of breathing space for a day or two.

Friday, October 12, 2007

From Chaos to Movement: The Story of a Friday

Entry for 12 Oct 2007:

I freaked out this morning: At that moment, although I’d spent most of the past week learning the NRES process and filling out the very long and confusing form, it was still unclear to me how long the University’s research office and ethics committee would take to re-review the Social Anxiety Research Protocol before they would approve it for me to go ahead with the NHS ethics process. In addition, I still have the NRES application for the practice-based recall protocol, which I haven’t started yet. This is holding up three manuscripts that I am supposed to be working on for various people, which were either late or about to be. And the manuscripts are holding up my doing my part of the meta-analysis that Beth is working enthusiastically away at, and that we are supposed to present the results of at three different conferences next month (including the high profile Improving Access to Psychological Therapies conference in London).

Meanwhile, we don’t have any clients yet for either the Social Anxiety study or the Practice-Based Research Protocol study, and we are expecting 4 or 5 students to start seeing clients in the latter protocol within the next month. (And our major source of clients, GP practices, is blocked to us until we get NRES approval, which is probably going take us into January.) ….In addition, the pre-test data collection for part of the diploma course study got messed up and so far we’ve only got about a 30% return rate (vs. 85% for the part-time course). Although I woke up this morning with a feeling of dread, I’d kept this to myself since I got up. Then, as I was about to go out the door with my bike and was saying goodbye to Diane, my tale of woe came pouring out. Then, just as I was winding down (or rather up), I got a phone call from Lorna, who needed me to cover the study groups on the fulltime diploma course for her. I dashed off to work.

In the course of the morning, I visited the diploma course students in the study groups, first getting their finishing time wrong and then having to go back to them and tell them the correct time. I finally faced the fact that I had to do something about the low return rate for the diploma course study. I discovered that the Social Anxiety ethics re-approval process was in danger of going sideways and required immediate intervention to get it back on track. And I discovered that we still hadn’t sorted out the flyer and poster design for the practice-based research protocol.

The low point (and turning point) of the day came when I showed up for the afternoon fulltime large group with a pile of diploma course study forms, hoping to catch some of the nonresponders… only to discover that I had forgotten to photocopy the information and consent forms. I sat there panicking, looking at the students.

Finally, I took a deep breath and tried to explain the situation to them as best I could. It turned out that Julie Folkes-Skinner, the U of Leicester whose dissertation research it is, had confused things by giving the students envelopes with her address for them to return the forms to her directly; however, I had told them to return them to us, as we had done with the part-time course. This led to confusion; some students had put stamps on the envelopes & mailed the forms back to Julie; others had tried to turn them in to the office and been told to mail them themselves (presumably because of the missing stamps) but hadn't because of postal strike, while others just hadn't got around to it or weren’t sure if we are still interested in getting them back. I left them with a plea to do their best to get the forms back to us as soon as possible and to let me know if they were willing to take part in Level II of the study. This at least clarified where the problem was and boded well for salvaging a decent return rate.

I went back to my office, to meet with Isabel on her MSc thesis about the study she is planning on counselling with the dying. Louise at the research office phoned a couple of times and grilled me about aspects of the Social Anxiety study, which began to look like it might get unstuck. Brian and I finalized the Practice-Based Research Protocol, making it more appealing. Beth had given me three important studies that she had analyzed, and somewhere in my wanderings I realized that it might be possible for us to take the meta-analysis to next month’s conferences without us both analyzing all the studies, that we could present a relatively complete set of studies combining our separate analyses, and then later (in December & January) analyze each other’s studies in order to check reliability as we had planned. Then, Lorna announced that she had gotten the cooperation of the Tom Allen Centre to give information about our two protocols to the clients on their long waiting list. Before going home, we had a very productive research committee meerting in which we made significant progress planning how we are going run the student placement aspect of the research clinic. The day concluded with a very nice book launch party for the new Handbook of Person-Centred Therapy, where there were speeches and songs and interesting people to talk to.

I still have the other ethics proposal to do, and those three articles, and I haven’t had a chance to talk to Beth about my idea for expediting the meta-analysis, but it’s hard to be pessimistic in the face of all this forward progress. Tomorrow we’re planning to visit the Glasgow’s famous Burrell Collection (I’ve never been), and last night we went to a great concert by an Australian duo named Cloudstreet. Things are pretty intense right now, but it’s great to realize that things really are moving forward, and to be able to balance all the hard work we’re all doing with some fun now and then.

Saturday, October 06, 2007

Mugdock Wood and Drumclog Moor: The Beginning of the West Highland Way

Entry for 5 Oct 2007:

For this week’s Saturday Adventure, we decided to take a walk on the West Highland Way, and in the process encountered some very interesting local place names and a ruined castle we had never heard of.

Even on Saturday, trains run from Hyndland to Milngavie, which is the beginning of the trail. (By the way, Milngavie is pronounced, “Mull-guy”, and is a confusing transliteration of the Gaelic for David’s Mill.) From there, we blundered about the town centre a bit until we found the trailhead.

The West Highland Way, at this point parallels the Alland Water, a busy stream flowing between often fairly steep banks. The beginning of the trail is not very nice, leading through an abandoned car park, complete with drunk sitting under a porch, then following a path between two walls. Then, an industrial park came into view on the other side of the river, on our left. Soon, however, we left the town behind and the views opened up on either side. Drumclog Moor, full of dying bracken, green and brown, lay on our right, sloping up the hill.

We came to two curved stones set in the path and carved with cursive writing, which we eventually (on the way back) figured out marked the boundary between Drumclog Moor and the Mugdock Wood. (Where do they get these names?; I have been unable to find this out…) We walked on, passing many people out with their dogs, all different kinds of dogs. Mugdock Wood is one of the heritage forests consisting of the original mixed trees, including many old gnarled oaks. It felt peaceful. I entertained myself with fantasies of walking or running the whole trail, which goes all the way to Fort William, 95 miles to the north.

We walked until we reached a road (Kyber Pass, this is called on the trail, an imperial allusion), about 2.5 miles from the beginning of the trail. We turned around and walked back to where we had seen a steep trail going off to the right (now our left), sign-posted for Mugdock Castle. I am a sucker for Scottish castles (of which there is said to be some 3000), so we headed in that direction, up the hill, then along a rather ratty and uneven board walk, and finally up a quite rocky path to the top of the hill.

… Where we found a large ruined castle, with a tall, intact keep and outer wall mostly intact, and the ruins of a large Victorian era mansion, last inhabited in the 1940’s. In 60 years, it had mostly fallen down, so that only the ground floor walls now remain, the rest of having been carted off in the form of rubble. We had no idea that there was castle here, and found ourselves sobered by how quickly it had fallen apart.

There were many people there, out enjoying the pleasant day; a south Asian family was being video-recorded by one their members. Small children ran noisily about, while teenagers climbed on the remaining walls, ignoring the signs warning them not to do so. Various signs indicated to that we had emerged into the middle of Mugdock Country Park, a large parkland which will require much more time to fully explore.

However, we needed to head back before our feet got too sore, so it was back down the hill, past more of stones with flowing, poetic writing set into the path. Back onto the West Highland Way, back through Milngavie, onto the train, and home again, another successful Saturday Adventure concluded.

Friday, October 05, 2007

Nice weather, dead washers, and NRES

Entry for 5 October:

Another week! From the vantage of Friday evening, it seems mostly like a blur at the moment, but we had a lovely visit with Katka, depositing her at Prestwick airport last night. Afterwards, Diane and I rode back through the dark autumn evening, pleased with the pleasant, cool weather. The rain had cleared out by yesterday morning, and today was lovely also. We’ll take it one day at a time for now.

The washing machine gave up the ghost this week, so Diane is looking at the Which? website, but it is a frustrating process, because they just don’t make washing machines here like they do in America. We continue to have a hard time getting our heads around 2 hour wash cycles and tiny loads. Fortunately, we don’t have children at home, but we are wondering if our supply of clean clothes will hold out until the landlord gets around to replacing the defunct machine.

The big shock of the week was finding out that we can’t even leave copies of our 1000 brochures on the Social Anxiety project in GP surgery waiting rooms without going through the arduous NHS ethics review process, now known as NRES (National Research Ethics Service). This, it turns out, involves a totally different set of forms and information that the University ethics process. If we’d known, we could have done this months ago, or even, in fact, in place of the University ethics review process; now we are reduced to putting up posters at supermarkets and libraries for the next two months or more while the NHS ethics process grinds forward. Still, it’s past time for us to get up to speed with this, so I have dug into the form, which is on-line, and managed to get through the first (and hopefully most difficult) seven pages of what turns out to be a 45-page form. Onward!

Wednesday, October 03, 2007

The Rain Returns but fails to dampen our spirits

Entry for 3 October:

The rain returned today, breaking the equinoctial spell of uncharacteristically clear and sunny weather we’ve been having for the past couple of weeks. Katka, whom we visited only 10 days ago in Dublin, is in Glasgow for a couple of days of training, so we went out to Amber Regent for a lovely meal (mixed appetisers, crispy aromatic lamb wrapped in a thin pancake/crepe; crispy duck with pineapple). Afterwards, we all got soaking wet walking her back to her hotel, in spite of coats and umbrella (only 1 between the three of us – maybe that was part of the problem!). Back home to the comfort of our flat, happy, somehow, with the pleasure of the connections that tie us all together.