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.)


John said...

I am definitely among the Type A group of counsellors. After 4 months of working in a project that offers counselling to people affected by their own or someone else's drug use I am coming to see the value developing Type B tendencies!

So often now I hear from all sorts of people that CBT is the way to handle this or that addiction. Sometimes the effect of this on me - newly emerged from a person-centred training course - is to cause me to question my own effectiveness. I am still looking to get a sense of what therapeutic change looks like in the lives of the people I work with.

Some way of evaluating such change seems important both from the point of view of the client and also from my point of view as a counsellor. I can see that doing the small-scale single case research project might be very useful in giving a sense of a way through this sense of not-knowing.

Incidentally, is there anything available around person-centred/process-experiential approach and working with people with addictions?


John said...

I am definitely amongst Type A people. After 4 months working in a project that offers counselling to people affected by their own or someone else's drug use I can see the value of developing some Type B tendencies!

Maybe I needed this experience in order to begin to see the need of some way of evaluating the usefulness of what is happening when I'm with a client. I find that so much is said about the effectiveness of CBT in working in the field of addictions that I am left with questions about the effectiveness of what I can offer. This is not to state here my lack of belief in the necessity and sufficiency of the therapeutic conditions, but it is to state that I feel challenged to know that I am being effective in enabling change to happen. Well, maybe I am wondering about the sufficiency of what it is I'm offering.

Looking at your comments about the single case research project, it seems useful to me. I can see that it could lead to greater confidence in being able to base practice on what has been shown to be effective.

Do you know of useful reading in this area of drug addiction regarding person-centred/process-experiential therapies?

Robert Elliott said...
This comment has been removed by the author.
Robert Elliott said...

There is a bit on Person-centred therapy with substance abuse, but for some reason counselors in the UK don't seem to know that Motivational Interviewing is really an application of person-centred/experiential therapy to substance abuse, especially as properly practiced by counselors with proper (i.e., person-centred) training. For this reason, we have included it in our response to the Scottish Government on improving access to psychological therapies by including person-centred counseling in official positions on a range of client problems, including substance abuse. See http://www.strath.ac.uk/Departments/counsunit/features/policy.html .
In the meantime, keep thinking seriously about getting involved in research!