Friday, December 28, 2007

Kenneth’s Christmas Tree

Entry for 26 December 2007:

When my youngest son, Kenneth, was about 6 years old, he brought a baby pine tree, 6 to 8 inches tall including roots, home from school one day in a plastic bag as an Earth Day project. What do you do with a grade school project tree? I couldn’t bear to let it rot in the plastic bag and throw it away, so I planted it in an empty planter next to the back driveway. For years it grew there, among the marigolds and impatiens that we planted each summer, surviving the harsh winters and the demise of multiple planters.

On arriving home in Toledo last week, Diane and I both spotted Kenneth’s tree – now more than four feet tall -- sitting on raised cement porch area behind the house next to the driveway. Independently, we each hatched the plan to recruit it for service as this year’s Christmas tree. Diane picked the dead needles off it and washed the grime off its big plastic planter, and we carefully carried it into the house, setting it up by the front window. There it made a dandy Christmas tree, especially after the kids decorated it with a modest string of lights and a few well-chosen ornaments. We don’t know how it will deal with being shifted between drastically different micro-climates (from cold and snowy in the teens and twenties – minus 8 to minus 5 in Celsius – to the dry indoors heat). But for this year at least, we are honoured to have Kenneth’s tree as a guest in our house, hosting the presents that gathered around it, a gift from the past.

Thursday, December 27, 2007

Return to Toledo; Fixing the Landline

Entry for 19-25 December 2007:

Northern Ohio and southern Michigan got 6 to 10 inches the day we flew back from Glasgow. We kept expecting to be told that our Amsterdam-Detroit flight had been cancelled on account of snow, but it didn’t happen. We chased the sun from Amsterdam to Detroit, and were delighted that the sky was still light when we touched down in Detroit about 6 in the evening. Two more hours of daylight (8 am to 5 pm) here than in Scotland right now! What a difference! We felt better immediately.

The snow had stopped and the sky was clear, but there was about 10 inches of new snow on the ground, and Linda was too wiped out from shovelling driveways most of the day to come and get us. Inconvenient, but we were so grateful just to have made it this far, that it was as if a bubble of grace surrounded us, insulating from a sense of hassle or panic. After considering our options (hotel? rental car? taxi?), we sprang for a Checker Taxi Company taxi ride from Detroit Metro to Toledo, for US$110 plus tip. Under previous circumstances we had balked at the expense, but the rental car was more expensive and less convenient, the road conditions uncertain at best, and the jet lag rode heavily on our brains. Given all that, we were very pleased to pay the middle-aged African-American woman to take us home. Her Detroit accent washed over us pleasantly as she chattered at us in response to our questions about her work, her cars, and her life, grace upon grace as we rode south in her black Lincoln Continental, a tank over frozen waters.

Toledo had had about 6 inches, but Linda had shovelled us out (thanks, Linda!), so the driveway was passable. There is now a grand piano in our living room, which is interesting, more bookshelves, and new curtains to cut winter heat loss, but beyond that little has changed since August. Linda is on a low carb diet, but we had been doing preventive eating all day and weren’t that hungry. What we were was extremely tired… so we crashed.

The next morning a host of tasks fell on us, but principal among them was the fact that (a) the upstairs shower handle had come off and broken and (b) our telephone landline was dead. Also, my malpractice insurance had been allowed to expire, as had Diane’s nursing license; our accountant had gone to Florida again just when we needed her; and my life insurance company was trying to cut our benefits drastically again. However, there is nothing like a good engineering crisis to demand one’s total attention.

But first we had to pick Kenneth up from Cleveland, where he had just finished his Greek final and was anxiously waiting from us to come pick him up. We’d warned him that we might be delayed in picking him up, but still he groaned when he realized that we were going to be 3 hours late (he hates being late…). Still, he was very glad to see us again, and chattered at us most of the way back to Toledo, narrating us through his latest computer game music CD and explaining the difference between square and triangular wave forms in early game music technology.

After trouble-shooting and testing our landline, I determined that the problem was ours rather than the phone company’s. However, the internal phone wiring, emanating from a pair of terminals among the roof beams and joists of the laundry room in the basement, was a chaotic spaghetti of different colored wires and phone cables snaking in from all directions and ending in tangle of green, red, yellow and brown wires, some connected to one of the terminals, others not. At first this made no sense at all, but over the course of the next days, I gradually learned to read the pattern. Close inspection showed that there was a problem with the phone cable leading from the Network Interface Device (NID) on the outside of the house through two layers of siding and wall to one of the two internal terminals: The insulating plastic or rubber of this cable, which appeared to be at least 50 years old, was cracked and split near where it disappeared into a hole in the outer layer of aluminium siding.

The first hardware store we tried had gone out of business sometime in the past 3 years, so, with some dread, we drove down to the dreaded Home Depot (known among the family as Home Despot because it has driven almost all of the small hardware stores in town out of business). Tuesday afternoon turned out to be a brilliant time for a hardware chore: Instead of being ignored and left to wander hopelessly among the vast aisles of the place, we were flocked with helpers, often travelling in pairs, who passed us from one to another, so that in 10 minutes we had solutions to both of our engineering problems.

There then ensued a long process of figuring out (a) which of the 8 wires in the new phone cable attached to the which terminal (answer: white with blue stripes = green; blue with white stripes = red); (b) how to get through the two layers of siding and wall, where it turned out that the newer aluminum siding had been put up around the old phone cable such that the two holes didn’t line up at all (answer: drill a new hole through the aluminum siding to match the other hole, while Kenneth used the new wire to tap repeatedly against the outer siding until his arm developed cramps; and (c) what order to do this all in (answer: strip the inside end of the new phone line first and attach it to the terminal inside, because it’s harder to work up in the ceiling of the laundry room than to stand around outside – assuming that the weather wasn’t too horrible)

After attaching the new cable to the terminal, while making sure that the old wires were still attached, I went outside, stuck the end through the rubber grommet piece at the bottom of the network interface device, stripped the outer and inner coverings off of it, and attached the appropriate white and blue wires to the green and red terminals. I then tested the different internal phone lines, and discovered that the most commonly used phone jack, in the dining room, didn’t work.

I thought I’d gotten all the wires attached, but apparently I’d missed a pair, which had somehow come loose in the process. I had ignored this pair because it was the wrong color (orange and orange with white stripes), and because the wire went off in the opposite direction from the dining room. Unfortunately, I couldn’t find any information about this type of wire, and so I didn’t know what polarity to use. I had Diane pick up the phone in the dining room and listen while I tested this pair of wires. This whole process involved tracking in and out of the house about 20 times, because whenever you work on the wiring you have to unplug the household wires from the phone company’s line, which carried 50 volts and can give a nasty shock.

Fortunately, the dining room phone circuit worked when I touched rogue pair of wires to the terminal. Success! I attached these additional wires firmly to the terminal, along with four pairs of green and red wires, feeling very proud of myself, and went off to visit Brendan and Mayumi in Cleveland for a couple of days.

Unfortunately, when we got back home again a couple of days later, the landline was dead again. It was extremely windy that day, and I wondered if the wind had done something to the new wire I’d run. No luck. After more testing and research, I concluded that the problem wasn’t the new wire I’d run, but instead was due to an internal short somewhere in the house phone circuits. That is, two wires were touching, closing the circuit and telling the phone company that a phone was off the hook, yielding a busy signal when called from the outside and a dead line from the inside. At this point, I didn’t feel up to tackling the internal phone wiring; however, AT&T’s service website and service phone line were both down. We resigned ourselves to sticking with our ancient cell phone for the immediate future.

After mulling it over for a day, I decided after all to tackle the internal wiring. With Brendan helping and my handy multi-meter, I first tested the new wire coming into the house and found it carrying 50 watts. I then disconnected the dodgy dining room line that I had had trouble with before: Viola’! Dial tone! The dining room line has a short in it (probably in the jack) and was taking down the internal landline whole system. I secured the other 5 pairs of wires (4 internal; 1 external) to the terminal, and taped over the dining room phone jack. Maybe I’ll try to fix that on my next trip back to Toledo, but for now this is good enough.

Tuesday, December 18, 2007

Research Clinic Progress & Advanced Research Training

Entry for 16 December 2007:

It has been a busy several weeks. Now, we’re on our way back to the US for three weeks holiday and to see our families, and I certainly feel that I’ve earned a break. (Actually, the general consensus of friends, family & colleagues is that I’m working too hard and need to cut back on something.)

Research Clinic. The research clinic is now operational, more than 20 potential clients have contacted us, and this past week the first three clients began therapy, two in the social anxiety and one in the practice-based research protocol (two others have been assigned to therapists and are awaiting first sessions). Three student counsellors have joined us so far and will be seeing clients in the new year as part of their training experience. We have been designing systems for tracking clients, scheduling rooms, communicating with security about building opening times, and supervising both research and therapy. I have been able to draw on my long experience running my research clinic at the University of Toledo, but there is less infrastructure in place here, and so we have had to design new processes beyond what I am familiar with. The research clinic’s demands are immediate and pressing, and thus need to be prioritized over most other demands, such as writing. Diane has been helping with phone screenings and intake/diagnostic interviewing, which has been a great help to me and Brian, but even so we have been run ragged. I think we are hoping that two or three weeks’ breathing space will enable us to finish sorting out the basic arrangements and to get caught up on our sleep. However, what is already becoming clear is how having a working research clinic provides a source of energy and excitement, and a focus for further developments.

Advanced Research Training in Qualitative Methods. In addition to the conference presentations of November (discussed in previous entries), I’ve also had a pretty full complement of teaching activities, including a new 2-day intensive Advanced Research Training in qualitative research last weekend, partly co-taught with John McLeod. There were 10 participants, including all of our current PhD students and some others. Almost all had previous experience doing qualitative research, which enabled us to start at a fairly high level. This was a new and refreshing experience, and we had many productive and useful discussions. In addition to the usual lectures on the methods and demonstrations of analytic practices (such as preparing the text for analysis), John and I developed a format of asking participants to take a couple minutes to write down “the questions that you will be sorry you didn’t ask after we are done”. The participants’ questions were excellent and served to generate productive discussions of practical topics such as making time in one’s life for working on research and how to support wider scientific acceptance of qualitative research.

A good esprit de corps developed among the participants, who collected each others’ email addresses and have now set up an email list for exchanging information, which John has been using to distribute particularly nice examples of qualitative research as a follow up on the workshop. And so we have begun to develop a third, advanced/doctoral, level in the system we are setting up for research training, to complement the diploma-level practice-based research training and the masters-level intermediate research training. Each of these groups of students has particular needs and so research training needs to be carefully targeted in content and level of material provided.

This experience in turn is helping us redesign the taught input for the MSc course for the next intake of students in September. For example, we are asking the PhD research students if they would like to help out with the series of intensive research days for we plan to offer next autumn, and also if they’d like to help supervision the MSc students, in a kind of pyramid model. This makes all kinds of sense, because it also helps prepare the PhD students for academic positions.

And the research clinic in turn opens up new possibilities for the research students to carry out their research, if we go to the trouble to make sure it all works together!

Tuesday, December 11, 2007

Trip to London and IAPT Conference

Entries for 1 & 11 December, 2007

Last March at UK SPR in Ravenscar, I met Jeremy Clark, a London psychoanalyst who was organizing a conference to address the Improving Access to Psychological Therapies (IAPT) initiative. His aim was and is to broaden the whole thing, in order to keep it from being totally hijacked by powerful CBT forces. We talked for a while, and I floated the possibility of my presenting the results of the person-centred/experiential meta-analysis, possibly the new updated version. In due course I sent him a copy of Elliott et al. (2004) and he invited me to take part.

So it was that, after teaching until 9pm on the last Wednesday of November, I found myself catching the Thursday 5.55am London train from Glasgow Central, in order to give my presentation on Friday. In the meantime, others had scheduled meetings around the IAPT Conference:

First, Sue Wheeler and Nancy Rowland had organized another meeting of the steering group for the ESRC-funded Researcher Development Initiative grant, which John McLeod and I are on. John couldn’t make it this time, so for my sins, I got myself volunteered to pull together an outline for a 5-day summer school on teaching introductory counselling research methods, plus an article for Counseling and Psychotherapy Research on the experiential model of research training. Both the summer school program and the article are to build on my 29 October blog entry from the last RDI meeting (“If I Ran the Zoo: A Modest Proposal for Training the Trainers”), which everyone involved with the project now appears to have read! I must confess that I feel somewhat intimidated by others’ support for this fairly radical approach. I’m not that used to groups of people going with my more radical ideas, so I certainly hope that my analysis of the issues in teaching counselling students about research and the likely useful strategies is correct. I wouldn’t want to lead all of us astray!

Second, Chris Evans and Tom Schroeder organized a meeting of the UK SPR Steering Committee over dinner at an Indian restaurant near Covent Garden. So I went from a long afternoon with my BACP friends to a long evening with my UK-SPR friends, which made for an extremely long day. The steering group has been struggling to get tasks done, and Chris was bemoaning this, so I suggested that part of the problem might be that we don’t really know each other that well and that we might very well spend some time “team building” by talking about ourselves, which we did to good effect. Apparently, my person-centred colleagues are wearing off on me! At any rate, we got through several important items and decided that it would be good idea to try to emphasize the positive aspects of the UK Regional chapter to the larger SPR executive committee and to our members. I was very grateful when I finally returned to my somewhat seedy hotel near King’s Cross train station and crashed.

Friday morning I woke up with the realization that my talk, scheduled for later that afternoon needed more work. After I grabbed breakfast, I made most of these changes and dashed off to find the meeting site, at Savoy Place near the Thames. This turned out to be the Institute for Electrical Engineering, and sported a statue of Dave Faraday outside and depictions of various important scientific figures around the inside of the building, including, I noted with pleasure, Lord Kelvin, a native Scot from the Glasgow area.

* * *
Coming back to this abandoned entry 10 days later (and after 25 hours of teaching last week), what stands out in my mind the most is the way in which the IAPT conference provided a total immersion experience in the multiple intercutting agendas of the major players in the IAPT debate and their impact on each other:
-Government officials smugly laying out the New World Order of IAPT, but coming across as overbearing and annoying, particularly to the…
-Mental health service users, invited but not entirely welcome guests at the party, who provided the major fire and interest with their anger and confrontation, annoying the government officials.
-Angry, defensive British psychoanalytic types (articulate but very little in the way of evidence).
-Entertaining American visitors (including my friend Jacques Barber), flown in for the occasion but somewhat above the fray and not entirely on the same planet as the rest of the crowd.
-Data mavens (like me) grinding through their research but not really part of the main action.
-The climatic Battle of the Professors (Michael Barkham & David Clarke, who managed to treat each other with considerable respect while still getting in lots of points for their side).
-Person-Centered and other counsellors (me, Mick, Sue Wheeler), scuttling about like early mammals in the late Jurassic, wondering who’s going to go extinct first.
-CBT folks silenced by the vocal criticisms of much of the crowd, hanging on the sidelines in what was supposed to be their moment of glory, visibly grinding their teeth.
In the end, it is obvious that the service users are a natural constituency for Person-Centred counselling and that we have totally missed the boat by not actively courting and collaborating with them.

It is equally obvious that the group dynamic by which the CBT folks were made to feel unwelcome and insulted at their own party is unhealthy and dangerous. In my opinion, this level of mistreatment and villification will only make them mean-spirited and more likely to feel justified in sticking it to everyone else. It is becoming very clear to me that dialogue among person-centred/experiential, psychodynamic and CBT folks is essential to our all moving forward. I have to confess to having engaged in a fair amount of CBT-bashing in the past, but I’m thinking that this is becoming increasingly counter-productive.

Tuesday, December 04, 2007

Client Change Review: A Therapist Self-Administered Version of the Change Interview (12/07)

Entry for 4 December 2007:

I developed this simplified version of the Client Change Interview in 2001, specifically for postgraduate students and other therapists or counsellors to use with their own clients, in situations in which it is not feasible to have a colleague or researchers interview one’s client. This revised version is presented here as a therapeutic task, and should be adapted to the particular counselling situation and client.

Task Marker: Client describes sense of significant progress; or reaches previously-agreed-upon review point (e.g., 8 or 10 sessions; end of therapy; end of semester).

General Approach. Facilitate an empathic exploration of the client’s experience of therapy/ counselling. For each topic listed, use open-ended questions plus empathic understanding responses to help the client elaborate on his/her experiences. Use the “anything else” probe (e.g., "Are there any other changes that you have noticed?") in a nondemanding way until the client runs out of things to say. This task should take 20-30 minutes.

Schedule of Questions:
1. What medications are you currently taking (can include dose, how long, last adjustment, herbal remedies)
2. What has therapy/counselling has been like so far? (How it has felt to be in therapy?)
3. What differences/changes (if any) have you noticed since therapy/counselling started? (e.g., doing, feeling, or thinking things differently from before; ideas about self or others; changes brought to your attention by others)
4. Has anything have changed for the worse since therapy/counselling started?
5. What do you feel has helped bring about these changes? What has helped make them possible?
6. Is there anything that hasn’t changed since therapy/counselling started, that you client wished had?
7. What has been most helpful about your therapy/counselling so far? (please give examples; may include general aspects, specific events).
8. Has there been anything about your therapy/counselling that might have been hindering, unhelpful, negative or disappointing? (may include general aspects, specific events).
9. Has there been anything about your therapy/counselling that has been difficult or painful but still OK or perhaps helpful?
10. Has anything been missing from therapy/counselling? Do you have any suggestions for improving it?

Sunday, December 02, 2007

Strathclyde Research Clinic Starts Seeing Clients

Entry for 29 November 2007:

After months of trying to figure out how to recruit clients for our two research protocols, Lorna and Brian finally contacted the Tom Allen Centre, a local voluntary (i.e., nonprofit) counselling agency. It turns out that, like many other similar agencies, they have a several-month waiting list. They agreed to provide clients on their waiting list with information about the Research Clinic.

As a result, beginning last week, clients have begun contacting us about both research protocols. Suddenly, we are in business! Since then, we have been receiving a steady stream of 1 or 2 new client contacts per day. Starting a new mental health agency, which is what we are, involves quite a bit of organizing, and there are many procedures and processes still being sorted. This is complicated by the fact that we are running two related but different research protocols. With lots of consultation from me, Brian and Diane have been trying out our phone pre-screening and intake screening procedures for each of the two protocols. They are getting the hang of the phone pre-screening, and are learning the ins and outs (sometimes the ups and downs) of the Personal Questionnaire (both protocols) and the SCID (social anxiety protocol). Next, they will take on the PDQ-4, the questionnaire-cum-structured interview we use to identify dysfunctional personality processes.

In the meantime, we have been interviewing and training 4 students for work in the Research Clinic as part of a counselling opportunity experience. Two students have already started and are being trained in the various procedures; we hope that the other two will begin soon, given that we are rapidly accumulating clients to be screened and counselled. We hope that they will be able to start seeing clients by next week. Diane and Brian are just ahead of them, sorting the procedures out and finding them clients.

There is a great deal of potential here: large numbers of clients to be seen, and counselors at various stages of training (including the folks in various stages of EFT training) interested in seeing clients in the two protocols. We are having to make lists of priorities for who gets to see clients, in what order.

There is much to do to get the Research Clinic really up and running: Details of supervision will have to be sorted. Filing systems, and methods of tracking (and not losing track of) clients need to be organized. Copies of the various research instruments are being made and assembled into packets. Next, rotas for phone pre-screenings and intakes need to be organized, and coverage of the research clinic at different hours and days, including evening hours, will have to be sorted. Space will quickly be at a premium, which means that overflow space and additional recording equipment will need to be acquired.

And those are just the immediate tasks: Beyond the logistics of seeing clients, we now need to set up regular staff meetings for managing all this; put in place practical procedures for implementing our data storage plans (e.g., making regular use of our secure video data storage system); and begin entering research data. The process of developing student research projects based in the research clinic has already begun.

Clearly, starting and managing a research clinic is a major commitment and a lot of work; but after the long wait to begin, it also a relief. Moreover, it is also energizing and exciting to return to the active interface between research and practice, to be able to touch into people’s lives, and to connect to the power of the relationship and the change processes that unfold in person-centred/experiential therapy.