Wednesday, December 31, 2008

Year’s End in Murray Creek

Entry for 30 December, 2008:

Murray Creek, second last day of year,
Daylight comes at seven;
We luxuriate in long early light.

Rising to run Murray Creek road,
Frost lingers on car and star thistle,
Mist rises, ghostly, lit by early sun.

Life slows, creek flows,
Gently, not yet in full spate,
Waiting for more winter rains.

Peace fills winter valley,
Slowly turning green;
Animals stir quietly, hardly seen.

Labyrinth waits, silent
Wet stones settling into earth,
Path littered with oak leaves.

Slow time hovers in the valley,
Pausing at year’s ending,
Land mending, work done, we rest.


Entry for 31 December 2008:

When I began keeping this blog 2 years and 4 months ago, it never occurred to me that I would ever get to 200 entries, let alone 300. However, interesting things kept happening and its function kept expanding, to include the politics of psychotherapy, therapy and research training, poetry, commentary on published articles and book chapters, and so on. And so, “by commodius vicus of recirculation” (to borrow a phrase from Joyce’s Finnegans Wake), I suddenly find myself at entry number 300, considering my starting point, the journey so far, and the future prospects.

My first entry, written 31 August 2006, but not posted until several days later, was entitled, “Arrival in New California”, and began as follows:
We have arrived safely in Scotland. As we flew into Glasgow yesterday, we suddenly noticed that there are hills and mountains all around, and of course the river Clyde broadening out toward the sea in the distance. It reminded us strongly of California in the winter, when everything is green. So we have decided that Scotland is our new California! A New California for our new life...

Journey through Old California. And of course, as I write this, we are in Old California, the place where I was born and lived my first 28 years. New Year’s Eve day dawned this morning, another clear, cool Northern California winter’s day, again frosty as it has been for the past several days. After breakfast and clearing out the lower house (my mom has stayed in the upper house since my dad died), we said goodbye to my mom until next August. Descending out of the foothills, just past Valley Springs, we encountered the fog that has blanketed the entire Central Valley, from Redding to Bakersfield, over the past day or two, leading to multi-car pile-ups on the major highways. San Andreas, as my mom noted, is “Above the fog and below the snow" Down in the great valley where I grew up, however, there’s been no wind lately and therefore nothing to blow away the fog, so here it sits.

Much of Northern California has so far had only about 5 inches of rain this season, on top of several years of drought, so there really isn’t much green yet as we pass Tracey and climb over the Altamont Pass. Diane marvels again at the sheer number of car and trucks, like us seemingly driving from nowhere to nowhere. American loves its cars, and California especially. Finally, near the top of the pass, the fog is beginning to burn off, and we are suddenly nearly blinded by the bright winter sun. This is the fourth time we’ve passed through here on this trip, and like the previous 3 trips the windmills of Altamont stand there, unturning, still, bereft of breeze, waitng in vain for a windy day. No, this isn’t really very Scottish afterall…

The Journey So Far

Why blog? This blog has provided me with an opportunity to meet a need I have to document, take note, express, create and reflect. Why do it in such a public way, I have been asked, and not as a diary or a private blog, shared only with a small circle of family and friends? This is as difficult to explain as it is true of my experience: The need in me that drives this blog is a need to express and communicate to others, or an Other. It is part of the same need that pushes me to write and publish articles, to present my work at conferences, and to write and read my poetry for audiences. It is a need to connect, to be heard, to make a difference in another’s experience, which is itself a need to be in contact and thereby to be real. This is an old and familiar part of me. To quote the comic strip, Calvin and Hobbes: “’I am significant!’, screamed the dust speck”. Scientific publications are great, and I’ve done lots of those (about 110 at last count), but they lack intimacy and immediacy, which is where the blog comes in.

Types of entries.
In general, entries fall on a spectrum from personal (typically labelled as “Personal experiences” or sometimes as “Poems and Dreams”) to professional (labelled variously as “*News”, “Articles”, “Research”, “Training Opportunities” etc), with some entries blending personal and professional content (e.g., some of the “Politics” entries). At some point, I started posting text versions of selected lectures and conference presentation and doing little commentary pieces when a new article was published. Over time, I would say, I’ve reduced the amount of personal content in relation to professional content, especially as the readership of the blog has increased to the point where it is likely that some of the readership is not necessarily friendly.

Rate of entries. At the beginning I wrote entries every day or two (highest number: 24 in September 2006; second highest number: 20: March 2007). At times, the rate of entries has slowed to a trickle (4 entries for Sept and October of 2008), but just when I thought I’d dried up, something in me would find the need to write something. Over the past year, I’ve produced on average one or two entries per week, which feels like a good number for this.

Blog Process. I do collect ideas for blog entries, although many are never written. At the end of each month, there are usually a couple unfinished entries, most of which will never be completed. I never compose directly in Blogger; instead, I draft entries first on my notebook computer, then copy them onto the Blog. I always revise entries before posting, sometimes extensively, so that posted versions are generally second drafts (but still contain typos and errors nevertheless). I occasionally go back and revise previously posted entries.

Reader comments invited. I think people find posting comments to this blog to the a bit of a pain, which is my theory for why there aren’t more comments posted. To begin with, you have to sign up for a Google account. Early on, I decided to moderate comments, after someone posted spam on the blog. That means you can’t post directly to my blog; instead, when you submit your comment, Blogger sends me an email message containing the comment and asking me if I want to publish or reject. I will publish any comment that is reasonably relevant and appropriate. Two recent comments that I rejected were ads, one for someone’s internet dating website and the other a dodgy-looking internet drug discount site pushing anti-anxiety medication! I think a lot of my serious readers have really interesting things to say but are too shy to post comments, so I would like to take this opportunity to encourage them to do so!

Future Prospects

What are my goals and resolutions for the 2009?

1. I’d like to continue doing 2 entries per week, along the same lines as before, continuing to mix personal and professional entries.
2. I certainly intend to continue documenting my views of developments in the politics of the helping professions in Scotland and the UK.
3. I plan to resume my “Saturday Adventure” entries of interesting sights around Scotland.
4. Although this blog is primarily a verbal medium, I’d like to include more photographs.
5. I’d like to write more about the social anxiety research we’re doing in the Research Clinic; I’ve had to be careful here because of confidentiality issues. Fortunately, as we accumulate more clients it becomes more possible to write generally about common, repeating clinical phenomena that are emerging in several different clients.
6. I’m hoping that new, unexpected and interesting things to write about will emerge. Part of the fun of doing this is the opportunity to follow new interesting developments!

For now, I wish you a peaceful and prosperous New Year.

Friday, December 26, 2008

Scottish Matrix Slights Person-Centred-Experiential Psychotherapies

Entry for 26 December 2008:

After some delay, the new template that is supposed to guide the delivery of psychological therapies for Scotland has been released, just in time for Christmas. The document is entitled, Mental Health in Scotland: A Guide to delivering evidence-based Psychological Therapies in Scotland: “The Matrix”, and was produced by NHS Education for Scotland (NES), drawing on inputs from experts. (I drafted the section on Social Anxiety/Social Phobia, which appears with some later additions by others.)

1. What is The Matrix?
To begin with, the stated purpose of the the Matrix document is, “to help NHS Boards:
• Deliver the range, volume and quality of Psychological Therapy required for the effective treatment of common mental health problems, and the achievement of ICP accreditation;
• Provide evidence-based psychological interventions in other key government priority areas; and
• Work towards reducing waiting times for Psychological Therapies in anticipation of future ‘referral to treatment’ targets,”
It does this by, among other things, ‘Summarising the most up-to-date advice on evidence-based interventions.’ In addition, there is the following qualitified disclaimer: “The Guidance is not intended to be prescriptive, but does offer guidance to local groups involved in the strategic planning and delivery of Psychological Therapies.”

The bulk of the document is a set of tables of recommended therapies organized into different common client presenting problems, for both adult and child populations.

2. How was The Matrix document constructed?
NHS Education Scotland assembled a collection of experts on different client presenting problems. I was asked to review the literature on social anxiety, presumably because there aren’t too many people working on it in Scotland. We were given a relatively short amount of time, less than 2 months, and encouraged where possible to rely on the NICE and SIGN guidelines, which are respectively the English and Scottish official summaries of research evidence and clinical recommendations for Evidence based practice. Since there are no published NICE or SIGN guidelines for Social Anxiety, I was on my own. Reviewing the literature on outcome for therapies for Social Anxiety/Social Phobia turned out to be interesting and useful for me, in spite of the lack of evidence for PCE therapies and the preponderance of CBT research. Interpolating from existing general effectiveness data and clinical reports, as well as our early outcome data from our Social Anxiety Protocol, I was able to return a level C rating for Psychodynamic and Humanistic-Person-Centred-Experiential therapies, that is, “No evidence to date but opinion suggests that this therapy might be helpful”. However, interesting as the experience was, it did confirm the misgivings that Steve Pilling had expressed to me about the Scottish equivalents of NICE being under-funded.

3. How does PCE therapy generally fare in The Matrix?
Given the approach of the Matrix (organizing guidelines by client present problems), the political climate (dominated by CBT), and current state of the scientific literature on PCE therapies (fairly scattered and focused on different research questions), it is not really surprising that Person-Centred therapy is mentioned exactly twice in the document, once one page 10, in a list of therapies commonly-practiced in Scotland, and again on page 40 in the Guideline for Social Anxiety/Social Phobia that I drafted, referred to above.

In other words, PCE therapies are virtually invisible. If NHS Boards follow the advice in the Matrix, they will not commission PCE therapists to provide services for any common group of clients.

There are many problems with the verdict of The Matrix document on PCE therapies: philosophical, political, scientific, practical etc. However, I want to focus on just one of these and just one client presenting problem:

4. The Matrix document fails to fairly summarize the existing scientific evidence on therapies for depression.
Mild-to-moderate is arguably to most common client presenting problem in practice settings. Actually, a mixture of depression and anxiety accompanied by various other issues is probably the most common, but Depression has become a kind of flagship diagnosis, an entry-point for new therapies vying for broader recognition.

This past September, SIGN (the Scottish Intercollegiate Guidelines Network, i.e., the Scottish equivalent of NICE) released its revised treatment guidelines for depression, on which The Matrix section on Depression appears to have been largely but not entirely based. Building on earlier work I’d done for the HPCE competence Expert Reference Group, I took the meta-analytic data that Beth Freire and I had collected and pulled out the depression studies, looking for patterns. As a result, I was able to derive the following recommendations that were missing from the draft SIGN Depression guidelines:
(1) Person-Centred/Experiential therapies in general for Mild to Moderate Depression: Evidence Level A: Highly Recommended
(2) Person-Centred Therapy for Mild to Moderate Depression: Level B: Recommended
(3) Process-Experiential/Emotion-Focused Therapy (PE-EFT) for Depression: Level A: Highly Recommended
(4) Person-Centred Therapy for Perinatal Depression: Level A: Highly Recommended
These recommendations are documented with citations to published RCT and meta-analytic data (the defining criteria for the different evidence levels) in a summary document. I sent my evidence document off to the SIGN folks, who thanked me for my input; I have heard nothing since then. For some reason, I never got around to posting this evidence document on this blog, so I remedying the situation by doing so now.

Meanwhile, the Depression section of The Matrix appears to have been added after the rest of the Matrix was developed, between the September and November draft versions, limiting the time for feedback on it. Moreover, in the November draft, it was clear that there were significant omissions, even when compared to the draft SIGN Guidelines. These omissions didn’t just involve PCE therapies: Psychodynamic therapy, Problem-solving therapy (for elderly depression clients), and generic Counselling had also been left out, as was much of the documentation for the recommendations. Accordingly, I sent off a proposed revision of the Depression Matrix recommendation to The Matrix folks. Unfortunately, this input and the associated scientific evidence are not reflected in the published version of The Matrix Depression recommendations, although the documentation has been added.

5. What should we do?
As a teenager, I remember reading in Arthur Koestler’s The Ghost in the Machine, something that has become one of my favorite quotations: “When in danger or in doubt, run in circles, scream and shout.” But is The Matrix verdict the End of the World As We Know It? The fight for recognition of PCE therapies is worldwide and involves scientific, political, educational and practical elements. One that we have learned over the past 15 years is that a single set-back isn’t the end. It’s damaging, as we have seen in Germany, where Person-Centred therapists have been fighting a rear-guard action against the government and the insurance industry for at least 10 years. These kinds of set-backs are bad for morale and can have serious negative consequences for practitioners working in an approach, such as losing their jobs.

However, conceding defeat would be worse and is not necessary; instead it is vital that HPCE therapists persevere and continue meet the challenges, using a variety of tactics. Here are some suggestions:

First, as noted, it is important not to give up, and not to take no for an answer. We can take heart from the fact that The Matrix Depression recommendations are already out of date, because they do not include the recent research evidence, which has so far been ignored by the relevant bodies. There is room for more negotiation.

Second, it seems to me that a useful next step is going to be political: Those of us who can vote (I can’t since I’m neither a British nor an EU citizen) need to contact their MSPs and to express concern about the scientific data left out of published version The Matrix. To do this, you will need to be in possession of the facts about the research (see accompanying summary of the depression research literature. The point here is that we don’t even have to attack The Matrix’s depression review on the basis of its standards, even though these aren’t particularly fair: By its own standards, HPCE therapies should be included in The Matrix at Level B or A (depending on the speicific knowledge claim you want to defend).

Third, we need to move ahead with more research on the use of HPCE therapies for depression, especially more RCTs. It appears that Michael King’s 2000) ground-breaking RCT comparing, Person-Centred, CBT and GP clinical management is now being discredited because Beck Depression Inventory scores were used rather than formal diagnostic interviews. We need to keep doing more and better research.

Fourth, it’s important for us to be in dialogue with our CBT brothers and sisters rather than attacking them. Most CBT folks that I’ve met are genuinely concerned first and foremost for client welfare and believe that scientific data can help us learn how to help our clients more effectively. We can make common cause with our CBT colleagues in helping government bodies more fairly evaluate the available research evidence.

Fifth, HPCE therapists need to make common cause with one another instead of fighting for their particular brand of HPCE therapy against the others. In Germany, Systemic therapy has recently been recognized by the government, on the basis of a broad, inclusive approach to the research data, while Person-Centred, Gestalt therapies, and Psychodrama languish because they refuse to cooperate with one another. We can no longer sustain this kind of divisive approach.

Additional Research Information on Person-Centred/Experiential (PCE) Therapy for Depression for SIGN Consultation

(Robert Elliott, version 2, 21 Sept 2008)
[Note: This is a consultation document prepared to provide input for the review process for the SIGN Guidelines on Mild-to-Moderate Depression. It is provided here as supporting documentation for the blog entry on the release of The Matrix guidelines documents on commissioning mental health services in Scotland.]

The purpose of this document is to provide additional evidence missing from the Draft SIGN Guideline for Non-pharmacological management of mild to moderate depression. Based on ongoing meta-analytic research being carried out at the University of Strathclyde (supported by a grant from the British Association for the Person-Centred Approach) we are proposing that the following information be added to the Guideline. Note that the draft guidelines refer only to generic counselling, without reference to the particular type of counselling. We summarize evidence specific to Person-centred/Experiential (PCE) therapy, including (a) general meta-analytic support for PCE therapies for depression, (b) strong RCT evidence for a particular form of PCE (Process-Experiential) to general clinical depression, and (c) strong RCT evidence for Person-centred therapy for a specific form of depression (postnatal). It is our view that this body of evidence warrants modification of the draft Guideline to include Person-Centred/Experiential therapy in its recommendations for psychosocial management of mild to moderate depression. I am happy to supply the supporting references cited in this document.

1. Person-Centred/Experiential therapies in general for Mild to Moderate Depression.
Meta-analytic evidence: A meta-analysis of 23 PCE therapy research studies (including 4 controlled and 16 comparative studies) reported large pre-post effect sizes and general and statistical equivalence to nonPCE therapies. The small number of controlled studies mostly involved small or unrepresentative samples. (An updated meta-analysis [Elliott & Freire, in preparation] includes 32 pre-post studies, 8 controlled studies, and 33 comparative outcome studies with comparable or more favourable results.) (Evidence level 1+)
(Grade of recommendation: A: Highly Recommended)

Elliott, R., Greenberg, L.S., & Lietaer, G. (2004). Research on Experiential Psychotherapies. In M.J. Lambert (Ed.), Bergin & Garfield‘s Handbook of psychotherapy and behavior change (5th ed.) (pp. 493-539), New York: Wiley.

2. Person-Centred Therapy for Mild to Moderate Depression:

(1) Extrapolated evidence: There is one large well-designed RCT with 62% diagnosed depressed clients, and pre-therapy depression measure scores typical of depressed samples, showing comparable outcomes to CBT across 2 randomized comparisons and one preference comparison. Another source of extrapolated evidence is research on Person-centred therapy for postnatal depression, reviewed in section 3 below. (1+ or 1++)
(2) Cohort study: In one large, unpublished analysis of depressed patients taken from a very large published naturalistic study, the depressed subgroup analysis finds no difference between Person-Centred, CBT and Psychodynamic therapies. (2++)
(Grade of recommendation: B: Recommended)

Elliott, R., Greenberg, L.S., & Lietaer, G. (2004). Research on Experiential Psychotherapies. In M.J. Lambert (Ed.), Bergin & Garfield‘s Handbook of psychotherapy and behavior change (5th ed.) (pp. 493-539), New York: Wiley.
King, M., Sibbald, B., Ward, E., Bower, P., Lloyd, M., Gabbay, M., & Byford, S. (2000). Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care. Health Technology Assessment, 4 (19). [Well-designed study with two embedded RCTs and one preference trial; 62% of clients met criteria for depression, but Beck Depression Inventory was used a primary outcome measure and mean pre-therapy scores were at levels typical of clinically depressed samples. Results for Person-Centred therapy were comparable to CBT.] (1+)
Stiles, W.B., Barkham, M., Mellor-Clark, J., Connell, J. (2007). An Addendum to "Effectiveness of Cognitive-Behavioural, Person-Centred, and Psychodynamic Therapies in UK Primary Care Routine Practice: Replication in a Larger Sample." Unpublished manuscript, Miami University, Ohio, USA. [Subsample analysis of larger published study (Stiles et al., 2007): Well-controlled naturalistic study in NHS primary care with large sample of clients identified as depressed by therapists; identical pretherapy scores with no difference in posttherapy outcomes among Person-centred, CBT and Psychodynamic.] (2++)
Stiles, W.B., Barkham, M., Mellor-Clark, J., Connell, J. (2007). Effectiveness of cognitive-Behavioural, person-centred, and psychodynamic therapies as practiced in UK primary care routine practice: replication in a larger sample. Psychological Medicine. Published online 10 September 2007. doi:10.1017/S0033291707001511.

3. Process-Experiential/Emotion-Focused Therapy (PE-EFT) for Depression:

Process-Experiential therapy (also known as Emotion-Focused Therapy) is an integrative form of Person-Centred therapy that incorporates other humanistic therapy techniques such as Gestalt Two Chair exercises into a treatment targetted for depression. There are three well-designed RCTs testing this approach, using medium-sized samples and conducted by two different research teams, comparing PE-EFT to other therapies in the treatment of Major Depressive Disorder. One of these studies found that PE-EFT had significantly better outcomes (including very low relapse rates) when compared to Person-Centred therapy. The other study found equivalent, and on some measures better, results than CBT. (1+ or 1 ++)
(Grade of recommendation: A)

Goldman, R. N., Greenberg, L. S., & Angus, L. (2006). The effects of adding emotion-focused interventions to the client-centered relationship conditions in the treatment of depressions. Psychotherapy Research, 16, 537-549. [Replication of Greenberg & Watson, 1998: Well-designed RCT with clinically depressed clients and medium-sized sample, comparing PE-EFT to Person-Centred therapy; outcomes were strongly and significantly better for PE-EFT.]
Greenberg, L.S., & Watson, J. (1998). Experiential therapy of depression: Differential effects of client-centered relationship conditions and process experiential interventions. Psychotherapy Research, 8, 210-224. [Well-designed RCT with clinically depressed clients and medium-sized sample, comparing PE-EFT to Person-Centred therapy; outcomes were slightly but not significantly better for PE-EFT.]
Watson, J.C., Gordon, L.B., Stermac, L., Kalogerakos, F., Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 71, 773-781. [Balanced researcher allegiance RCT comparing PE-EFT to CBT in clinically depressed sample; outcomes for PE-EFT were generally at least as good as CBT and on some measures were better.]

4. Person-Centred Therapy for Perinatal Depression:

Perinatal depression is currently excluded from the draft guideline; however, the current SIGN guideline for Postnatal depression and puerperal psychosis states, “Postnatal depression should be managed in the same way as depression at any other time, but with the additional considerations regarding the use of antidepressants when breast feeding and in pregnancy.” In other words, the major difference between the treatment of postpartum depression and depression more generally is that antidepressant medication should be used more cautiously. There are four reasonably well-designed RCTs for perinatal depression with medium to large sample sizes that show superiority to treatment as usual (3 studies) or no difference in comparison to CBT (2 studies) or short-term Psychodynamic therapy (1 study). We are proposing this important population be included in this guideline, on the basis of these studies; in addition, we suggest that this body of research is relevant to the effectiveness of Person-centred therapy with depression more generally. (Level of evidence: 1+ or 1++) (Grade of recommendation: specific to Perinatal depression: A; extrapolated to depression generally: B)

Cooper, P. J., Murray, L., Wilson, A., & Romaniuk, H. (2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. British Journal of Psychiatry,182, 412-419 . [Well-designed RCT; Person-centred comparable outcome to CBT and Psychodynamic]
Holden, J.M., Sagovsky, R., & Cox, J.L. (1989). Counselling in a general practice
setting: Controlled study of health visitor intervention in treatment of postnatal depression. British Medical Journal, 298, 223-226. [Medium-sized RCT: Clients in Person-centred therapy had better outcomes than control clients]
Morrell CJ, Warner R, Slade P, Paley G, Dixon S, Walters SJ, Brugha T, Barkham M, Parry G, Nicholl J. (In Press). Clinical effectiveness of health visitor training in psychological interventions for postnatal women – a pragmatic cluster-randomised trial in primary care. British Medical Journal. [RCT; Person-centred similar outcome to CBT, better than treatment as usual]
Wickberg, B., & Hwang, C. P. (1996). Counselling of postnatal depression: A controlled study on a population based Swedish sample. Journal of Affective Disorders, 39, 209-216. [RCT; Person-centred much better than treatment as usual]

Monday, December 22, 2008

Winter Solstice 2008 in Toledo

Entry for 21/22 December 2008:

We arrived in Toledo without delay or mishap, which is always a relief; however, the weather has been formidable. Two days earlier, Toledo got 6 inches of snow, followed by freezing rain, so the roads and our driveway were a mess. After a quick bite at our favorite Chinese restaurant, we went home and crashed.

Officially, the winter solstice occurred about 7am the next morning. with a bit more than 9 hours of daylight Toledo, compared with 7 hours in Glasgow. We woke up to the howling wind. Winter had arrived. Or rather winter was here already, and we had arrived in Winter. By nightfall, the temperature had fallen to around 0 degrees Fahrenheit. None of your wimpy 0 Celsius; this was the real 0, bitterly cold, -18 degrees Celsius, with the icy wind gusting at 30 mph (50 kph), bringing the wind chill at times down to –25 degrees F (-32 C). It cut through my medium-weight coat like a knife. After two and half years of living in the temperate, Gulf-stream-warmed Scottish lowlands, we’ve lost our Midwestern winter conditioning, and I had neglected to take my serious winter coat out of deep storage.

Not without reason does “Glasgow” mean “dear green place”; but the American Midwest in the throes of winter is neither green nor dear. Instead, like C.S. Lewis’ Aslan, it is “not a tame beast” but is instead full of intense majesty: ice flung by the wind to rattle ominously against our bedroom windows; our car spinning out on the ice in a back street in our neighborhood so that we almost rang into a large tree (saved by bank of frozen snow!); snow blowing desolately across the highway as we drove to Cleveland to pick up Kenneth; and along the way sun glinting magically off the trees, still covered with ice from the earlier freezing rain. Kenneth went out to meet us as we arrived, huddled against the blast in his coat, the last person left in his dorm, waiting for his parents' return. It was so good to see him; he chattered at us all the way back to Toledo.

So we are in Winter now, but the snow and longer daylight makes everything feel lighter, less dark and heavy. I woke earlier again today (Monday), my head full of things to write about. It is lovely to be here in our other home, listenign to the wind blow outside, Kenneth sleeping next door in his old room, with Christmas once again almost upon us.

Saturday, December 20, 2008

Sleepless in Glasgow

Entry for 20 December 2008 (en route to USA):

I don’t usually have trouble sleeping, and I’ve been needing extra sleep for the past month as I recovered from the bug that laid me low. Even now, every time I end up a bit short on my sleep, the cough kicks in again, just to remind me that I’m still not completely well. So it was that as I got into bed last night after a very full and exhausting week, the last week in the run-up to my Christmas holiday, I fully expected to fall asleep without much effort.

Unfortunately, as soon as I turned off the light, I found myself wide awake. I tossed and turned for a good half an hour, then, remembering the standard advice, got up and read for an hour before trying again, finally falling asleep at 2am.

As I lay there, and even this morning, as I wait for our flight to Amsterdam, the first leg of our voyage back to Ohio, I am still puzzled by what happened last night. It can be looked at as a Problematic Reaction Point, so I could try to unpack my puzzling sleeplessness using Systematic Evocation Unfolding. However, last night it felt more like an Unclear Felt Sense, and I tried to Focus on it, with limited success. I suppose that Ann Weiser Cornell would say that I wasn’t able to be fully in presence with it, because I found myself feeling impatient with it: “For once you’re ready before a trip: you’ve done your essential email, you’re all packed, why can’t you sleep!” In retrospect, the Focusing was at least a partial success; it just didn’t help me fall asleep… and of course the impatience got in the way of sleeping also.

I did make some headway with the felt sense, though: It felt a bit like a caffeine-induced unsleepiness, but not exactly. Hmm… there was something like the feeling of excitement I used to get on Christmas eve, waiting for the next day to arrive, wishing I would just fall asleep to make the time go faster but being prevented from doing so by the very excitement to arrive there. So I was clearly excited to get out of the dark, big-city, still-after-2-and-a-half years-somewhat alien life here and back to the two-hours-of-light-more-a-day, suburban, easy familiarity of Toledo (and from there North California). And my kids and the rest of my family… and Christmas.

“Ridiculous!”, said something adult and impatient in me. “You’re not 7 years old, and you don’t really even want anything for Christmas this year. You’re going back a home that isn’t really a home anymore. Sure, you’re looking forward to seeing your kids and larger family again, but that’s not something to lose sleep over!” So I lay there tossing and turning, until I finally gave in to the sleeplessness and got up again. As I said, I was having difficulty being patient with myself, but the getting up was in a way a way of at least acknowledging the validity of the sleeplessness.

This morning I still find myself wondering about, and Unfolding, in a Focusing sort of way, the episode a bit: Some things that felt connected:

First, it has been an intense week, including two different intense processing sessions that revealed deep truths about my relationships with others and left me both drained and more fully appreciative of these situations and their sources. At some level, this feels quite important, although the implications need time to play out. But I’m left with a sense of excitement somewhere in me, about possibilities for new ways of being with others.

Second, there is sense of intellectual excitement over a new possible collaboration with a very diverse collection of colleagues from all over the University, around work on practical applications of Complexity Theory, something I’d looked into years earlier. Ernesto Estrada, recently arrived (about the same time as Lucia, but from Spain instead of Italy) to take up a new Chair of Complexity Science (cross-appointed in Math and Physics), is leading this effort. The developing project is helping me to think about the connection between significant therapy events and complexity theory, using Ernesto’s framework: internal structure (the person’s internal complexity of multiple voices or emotion schemes and modes of engagement); and external forces (the therapeutic framework, which provides a context that changes the equilibrium of the person’s internal organization). This has stimulated my scientific imagination, leaving me with a sense of excitement about the possibilities, not the least of which is the chance to interact with some of the best minds in this science-and-technology-oriented university, which I am coming to realize has a lot in common with Case Western Reserve University (Cleveland, Ohio), where my kids have gone to school.

Third, there is something bubbling away here about the RAE, or Research Assessment Exercise, the initial report for which was reported two days ago. The RAE happens every 7 years in British universities, and is a Big Deal. In addition to status, universities get more money from the government if they get higher RAE scores. I’ve got tons of publications (about 110 at last count), but they only look at the past 7 years, and it hasn’t really been clear exactly what the review panels have been looking for, so I don’t know if my individual submission will meet expectations or not (the individual results apparently will not be available for some time). I’ve been fairly nervous about this, because I was hired as part of an effort to improve the Education Faculty’s RAE ratings, and the Powers That Be will not be happy with me if I don’t do well. In fact, a couple of hours before I went to bed, I’d read our Vice Dean’s pessimistic assessment of our overall results, so that was definitely percolating in the background as I lay awake, a source of indeterminate worry.

Fourth, I realized that my body had a kind of unexercised untiredness, like it hadn’t been used enough. I’ve done very little running in the past two months; now with my energy coming back, it begins to feel like I’m missing the tiredness that comes from having run 3, 5, 6 or even 8 miles. So the unsleepiness also felt a bit like my body saying that it hadn’t been used enough. This didn’t help me sleep, so the impatient part that wanted sleep didn’t appreciate it at the time, but it’s an important message to hear and to do something about.

So no wonder I was having trouble sleeping… and one more thing: This morning, getting up on 5 hours of sleep, felt familiar in itself, comfortable, as if one is supposed to start one’s Christmas vacation tired, dozing on the plane, relieved just to be away from it all. It is the proper mode for travel, especially when you are going to be packed into a large tin can for many, many hours, waiting, suspended between here and there, now and then, waiting to arrive. Instead of Dramamine or alcohol, I have my tiredness to keep me company and temper the journey into a bearable, even enjoyable, time between.

Saturday, December 06, 2008

New Diploma Course Director Arrives

Entry for 5 December 2008:

As I’ve mentioned before, since Tracey Sander left last July, I’ve been Acting Course Director for our three Postgraduate Counselling Diploma courses, along with all my other duties. I’ve been able to survive this by virtue of a lot of help various people: Rachel in the Counselling Unit Office reminded me when things needed to be done, and nagged me when I forgot about them or when the email got buried in the 700 emails in my in-box. Alison Cumming picked up Tracey’s Personal and Professional Development group on the Monday Part-time course. Terry Daly helped the overseas students find placements and took on the monthly Deferrer’s group (for students from the last year or two who are still working on completing their requirements). Various members of the part-time teaching staff continued the pattern initiated by Tracey, of helping out with administrative tasks such as course timetabling and room booking.

For the past five months, some things got forgotten or left aside, while other things were not done with the style or grace with which they had been done before, but somehow we have managed to muddle through.

This week, however, to our great relief, our new course director, Lucia Berdondini, arrived. Lucia is highly focused, enthusiastic Italian woman with an easy smile and a direct but friendly manner. She was trained in Gestalt and Person-Centred therapies and lived in England for 13 years before going back to Florence 3 years ago. She found contemporary Italian politics and life no longer to her liking, and has been eager to return to the UK. She says that she has always wanted to live in Scotland. Although she is just beginning to learn what the job entails, it is a great relief to have her join us, and I for one am looking forward to having a new colleague to bounce ideas off of.

When she saw the ad for the course director position, she says she learned about the Counselling Unit not only from our regular website but also from this blog. I can only hope that the reality doesn’t prove to be too far off the mark from her experience. I don’t make any claims that my perceptions of reality, as represented here, match those of other people!

We invited her to come along to a large group session on the Monday Part-time course on her very first day at work, and she was very impressed with the quality of the interaction among the students she observed. It was a process she recognized entirely from the course she trained on and has taught on, and so I think it helped her feel at home here. And it is a great relief for me to have the company. Even though the early December days are short and the nights long (and this week cold and icy) we are doing our best to help her feel welcome. Welcome, Lucia!

Monday, December 01, 2008

Bracketing in Psychotherapy Research

Entry for 30 November 2008:

In the midst of the run-up to Thanksgiving, my old friend Connie Fischer contacted me for some help with a manuscript on “Bracketing” she was writing for Psychotherapy Research. Clara Hill was asking her for an example from therapy research. Since Connie’s area is psychological testing, she was a bit a stumped and wanted to know if I could provide her with an example. (Connie does wonderful stuff on humanistic approaches to psychological assessment, among other things.)

This was an interesting question for me, because of the short pieces I’ve written recently for the Applied Educational Research course website, on the Hermeneutic Circle and Sensitizing Categories (also posted on this blog). Bracketing is an interesting linguistic metaphor (brackets are what Americans call parentheses), and yet another take on issues of researchers’ prior understandings and what to do with these. While I don’t think that complete bracketing is possible, I do firmly believe that the attempt to bracket expectations and preferences for one’s data is an essential aspect of a responsible scientific process, because it helps open us up to what are informants are trying to tell us. In this sense, bracketing is close to my heart.

Accordingly, I sat right down and wrote the following example of bracketing in psychotherapy research for Connie:
For example, in their study of significant insight events in psychodynamic and cogntive-behavioral therapies, Elliott et al. (1994) attempted to bracket their expectations for what they would find: At the beginning of their study, the members of the research team wrote down what they thought they might find. They then literally stuck these expectations away during the conduct of the study, attempting to hear as clearly as possible what the data were telling them. In addition, at the end of the study, in order to capture their emergent expectations, they repeated this process, finally rating all the categories they had obtained for the extent to which they now realized they had expected these. They thus accomplished the double movement of both reflecting on their pre-understandings while also consciously striving to be open to their data. Beyond this, they were able to demonstrate the success of their bracketing, by showing that their actual findings differed from their expectations: that is, they had found things they hadn't expected and also failed to find other things that they had expected.
As for Connie’s take on bracketing and what she did with the example I sent her, we’ll all just have to wait for her paper, which will be coming out in Psychotherapy Research in 2009, as part of a special issued on research methods. Look for it!


Elliott, R., Shapiro, D.A., Firth-Cozens, J., Stiles, W.B., Hardy, G., Llewelyn, S.P, & Margison, F. (1994). Comprehensive process analysis of insight events in cognitive-behavioral and psychodynamic-interpersonal therapies. Journal of Counseling Psychology, 41, 449-463.

Sunday, November 30, 2008

Glasgow Thanksgiving 2008

Entry for 29 November 2008:

For several years, I missed Thanksgiving from travelling, twice to Belgium and once to Rome. For this reason, it was important not to miss out this year. We collected some fellow ex-patriot American friends from church, Melissa and her three daughters, plus Franny and Robert (a native of New Zealand and a Brit) and put on a regular American Thanksgiving feast, complete with turkey, green beans, green and fruit salads, bread, vegetarian entre’, as well as special dishes: cranberry-orange relish (ours) and southern sweet potato mash in hollowed out oranges topped with melted marshmallows (Melissa’s). And to top it off: pumpkin pie made from pumpkin we’d cooked ourselves (with a little help from a some canned pumpkin that my friend Jo had found for me at a store in Edinburgh). It was all great, but the pumpkin pie was a particular hit with the kids and adults alike.

Franny questioned us about Thanksgiving, as she tried to find the cultural equivalent in the UK, but the best she could come up with was Christmas dinner. Do we have any rituals associated with Thanksgiving, like the Queen’s Speech or Christmas crackers? Not really, unless you count watching (American) football (which none of us do). No, it’s really all about the food and the gathering of family. By the end, we were all quite full from eating so much, had had lovely conversation, and felt quite satisfied with our own slightly-delayed Scottish version of Thanksgiving.

Of course, Thanksgiving is also a time to give thanks, although this too is not really part of any particular ritual. I like to think about things to be thankful for:

1. I was finally feeling well enough today to go out for a run. I took it easy, since it’s been 5 weeks since I ran last and I still have a bit of the cough left. Even though it was a cold morning, it felt great to get out on the road again. It’s great to be feeling better, too.

2. I’ve finally begun making progress on my adjudicated HSCED paper, which I’ve been sitting on for 5(!) years. It needs a lot of work to deal with the 10 pages of editorial feedback, but really needs to be done soon. So I’ve been working on it for 15 minutes each morning. It may take me months to finish the revisions at this rate, but if I had done this 5 years ago, the thing would have been finished at least 4 and a half years ago…

3. Lucia, our new diploma course director, has arrived in Glasgow full of enthusiasm, and I had a good visit with my colleague Lorna, so it’s clear that Help Is On The Way.

4. With my friend Antonio Pascual-Leone, an EFT researcher and ex-student of Les Greenberg’s, and one of Les’ current students, Susan Wnuk, we have put together a nice little panel for the SPR meeting next June in Santiago, Chile, on research advances in EFT.

5. Relatedly, data are really beginning emerge from our Social Anxiety study in the research clinic, and the outcome results in particular so far are looking very promising. It’s really good to see this moving forward, and we are following up various leads for funding the next stage of this research.

6. Our families are doing well, including our kids, who have managed to find themselves surrogate families to celebrate Thanksgiving with. I'm really looking forward to seeing them, along with our US friends and family in a few weeks.

Saturday, November 22, 2008

Workload and EPS Retirement Event

Entry for 21 November 2008:

I’ve been essentially working three jobs for the past couple of months, covering for Tracey, our former course director, who left in July, and for Lorna, one of our lecturers and our finance person, who has been off on extended medical leave since September. Fortunately, I’ve had some help from various people, for which I’m very grateful, but it’s actually been fairly stressful. I haven’t done as well as I would have liked at these various duties, most of which I didn’t really understand when I took them over. It’s been an education, and I must say that I now understand the system much better than I did previously.

However, all the extra teaching and admin has finally taken its toll, and I came down with a very bad cold about 2 weeks ago. I’m now left with a lingering cough and am still feeling somewhat run down. Holing up at home for the past two weekends has helped, as has getting extra rest, but meanwhile the email has continued to mount ever upwards and important tasks have not always been done in a timely manner.

One of the people who has really helped me get through this difficult time has been Mike Hough, whose department retirement function was yesterday. Mike and another Educational and Professional Studies colleague, David Cornwell, were treated to a thoughtful and well-attended retirement party, complete with 1960’s music and a wide variety of snacks.

These leaving functions have become a regular feature of life on the Jordanhill campus of the University of Strathclyde. In addition to the general aging of the faculty and staff, the frequency of these events also reflects the fact that life in the Education Faculty has become more difficult for most people, including faculty, staff and sometimes students as well. Between strong pressure to increase research productivity and a serious budget shortfall for the Education Faculty (=college of education in American terms), there is more pressure being brought to bear on everyone here, much of it the result of criticism and directives from the upper administration. Staff who leave or go on medical leave aren’t replaced, budgets have been cut, and those of us who remain are asked to do more and more. Some of this trickles down to the student level, as Terry and I learned this week when we spoke to a group of angry overseas students from the fulltime diploma course, who complained that they are not receiving adequate support and are therefore being short-changed.

I had been asked to say a few words at Mike’s retirement event, but was not prepared for what turned out to be a more formal, involved process than I had expected. Mike and his colleague have each been at Jordanhill for more than 30 years, and about 60 people showed up to see them off and hear the speeches. I’d jotted down a few notes, but hastily added to them once saw what was expected. Mike has been a good colleague to me, caring, wise and passionate (as I said in my remarks), and has really provided a bridge for me to connect me to the rest of the EPS department. As a result I have met new colleagues whom I respect and to whom I enjoy speaking. As I gave my little speech, I looked out over the assemblage of people gathered to say goodbye to two well-loved colleagues. A powerful sense of community came over me. This is a group of people who care about one another, who have history with this place and each other. Afterwards quite a few people, including Mike, thanked me for my brief but heart-felt words. As a result, I myself now feel more connected to and part of this community.

It is a crazy time for all of us, but it’s clear that most of us care deeply about our students and the work, and that this commitment unites us in the face of the difficulties. I’m pleased to be part of it. And I’m very much looking forward to the arrival of the new course director, Lucia Berdondini, next week, and the return of Lorna in January.

Tuesday, November 18, 2008

Sensitizing Categories

Entry for 17 November 2008:

Here is another little methods piece I did for the University’s research methods website, which I think is of more general interest.

Sensitizing categories, as proposed by Glaser & Strauss (1967), are concepts brought by researchers to aid qualitative analyses, but which do not unduly affect the results the emerge from the data. In addition to being potentially useful tools, the concept of whether or not to consciously employ sensitizing categories in one’s research raises important general issues for qualitative researchers to consider.

1. Before starting a qualitative study, should I avoid reading the literature, in order to keep an open mind?

In 1980’s, at the beginning of the qualitative revolution in social science research, many researchers were convinced that the only way to escape the narrowness of previous quantitative social science research was to avoid reading about your topic until after collecting and analyzing your data. In this way, by keeping your mind in a pristine condition, you would be able to maintain an unbiased view of the data. You wouldn’t have to “bracket” your assumptions (a favourite metaphor of phenomenologists), because you wouldn’t have any assumptions.

This view is attributed to Glaser and Strauss (1967), founders of the Grounded Theory approach to qualitative research, and Glaser (1978; as opposed to Strauss, 1998) does in fact advocate avoiding doing pre-research literature reviews. This has a certain appeal, and also justifies jumping right into one’s research without lengthy, boring sitting around in libraries reading books and articles. You could go directly, “back to the things themselves” (to quote the famous dictum of the phenomenologist Husserl, 1913/1982).
Questions for reflection:
•Why is this no longer the dominant view of qualitative researchers?
•Whose interests might be served by a return to a more traditional view of “literature review first”?
•Under what conditions might “literature-free” research be justified?
•How can qualitative research retain its openness and freedom, while still grounding itself in the relevant scientific literature?

The inevitability of “bias”

Whether the belief in assumption-free qualitative research can be best understand as misplaced optimism about the openness of the human mind, as an expression of laziness, or as dangerous naiveté leading to unconscious, unchecked bias, it is not the dominant view of qualitative researchers today. In fact, it’s not clear that this “eternal sunshine of the spotless mind” was ever really subscribed by more than a few qualitative zealots. For example, an important early text (Bogdan & Taylor, 1975) urges readers preparing to do qualitative observational studies to read the literature in preparation for entering the field, so as to avoid committing faux pas with informants. Clearly, it is necessary to know something about what you are studying before starting to collect data; the question is, what and how much? There is also the question of how to use what one does know.

Philosophers since Kant have generally understood that it is impossible to know anything without bringing some prior knowledge, or forestructure, along. Not only is it impossible not to drag one’s prior knowledge along, but this prior knowledge is what makes the knowing possible. Without prior assumptions, categories, and words, we would be faced with what the American psychologist-philosopher William James (1890) referred to as a “buzzing, blooming confusion”, in other words, chaos. We wouldn’t even know there was something there to be known; everything would sound like noise, that is, meaningless, random stuff. For example, even something as seemingly straightforwardly obvious as an impression of the colour red is only made possible by the fact that our sensory system is biologically tuned to certain light frequencies and culturally programmed to divide the light spectrum into certain major categories. Awareness of these prior knowledge structures has led to whole fields of study into the nature and content of the human knowledge system, including perceptual and cognitive psychology, depth psychology (psychoanalytic and Jungian), cultural anthropology, and ethnomethology (Garfinkel, 1967), among others.

Even worse, failure to acknowledge the role, influence, or aid of prior knowledge means that we cannot therefore know the extent to which we are being limited or influenced by that knowledge, thus blinding us to our biases, whether these are biological, psychological or cultural in origin.
Exercise: Take a blank piece of printer paper. Fold it half the short way, top to bottom. Run your finger along the fold, looking carefully at how the paper has taken the fold. Now unfold the paper, and fold it the long way, right to left. Once again, take a close look at the fold, at how bumpy or not the fold is. Note that that one of the two folds you made is much more smooth while the other is more bumpy. The bumpy fold was done against or across what is referred to as the bias or grain of the paper, while the smooth fold was done with the bias or grain.
Finally, find a good dictionary and look up the meaning and origin of the word “bias”. Why is there bias in paper? What other things have bias? Is it possible or even desirable to make “unbiased” paper? What implications does this parable have for research in general, and qualitative research in particular? What does this have to do with the concept of “sensitizing categories”?

Using Sensitizing Categories

In retrospect, Glaser’s (1978) argument against pre-research literature reviews appears to have been misunderstood. First, he doesn’t say you should read nothing. Rather, his view is that the researcher should read books on qualitative method, especially his books, to help you develop an open, creative approach to your data. He also says you shouldn’t record your interviews or talk to anybody about your emerging theory (Wikipedia, 2008); fortunately, nobody today listens to those methodological guidelines either! Second, the reason Glaser says it’s a bad idea to read the research literature before doing your research is that it will desensitize you, that is, make it more difficult for you to hear what your data are trying to tell you. He doesn’t want you to read right past your data, saying to yourself, “Oh, of course that’s an example of X”, rather than stopping to really listen to what a participant is trying to tell you. So the real point is that anything that interferes with hearing your data with a fresh, curious ear is bad and should be minimized.

But Glaser (1978) also argues in favour of “theoretical sensitivity”, the use of sensitizing concepts that help you hear what is going on in your data. How is this possible?

Glaser (1978) and Strauss (Strauss & Corbin, 1998) famously disagreed on how to do this. While Glaser favours a more open-ended, creative, unstructured use of prior concepts, Strauss and Corbin put forward a “paradigm” of organizing categories, which is the basis of what they refer to as “axial coding” (i.e., organizing your data within a set of broad headings or domains). Exactly what this means is subject to varying interpretation. On the one hand, it can be understood as a general social theory that can be applied to a wide range of social phenomena, as Strauss & Corbin appear to imply. On the other hand, others (e.g., Elliott & Timulak, 2005) argue that the axial coding or domain structure of a topic emerges over the course of analyzing the first 3 to 5 interview protocols, and reflecting the interaction between the researcher’s interests and what participants are interested in telling about the topic. For example, it is appears to be common for informants to want to say much more about the background or context of the phenomenon than the researcher is interested in studying(e.g., Rhodes et al., 1994).

Sensitizing categories as research topic domains. In this latter view, then, the most useful sensitizing categories are broad headings that remind the researcher to listen for particular aspects of experiences, without constraining the specific nature of those aspects. For example, it is generally useful to organize one’s topic into a set of domains or subtopics such as:
• Context: What led up the targeted experience (e.g., realizing one’s ordinary way of seeing something was wrong; struggling and feeling confused; considering different possibilities; etc)
• Experience: What happened during the targeted experience (e.g., understanding a scientific concept such as gravity)
• Effects: What happened afterward, or flowed out of the targeted experience (e.g., feeling clarity and relief; applying the concept to other situations)
While such a framework of sensitizing categories or research domains seems obvious and straightforward, it often turns out need further adaptation. For example, participants may have little to say about the effects of an experience, but may make an important distinction between the immediate context or situation in which the experience occurs and its deeper context or background earlier in person’s studies or life. Thus, it seems important for the researcher to hold these sensitizing categories lightly and to be ready to adapt them to fit the particular research topic and data.

At the same time, even a primitive set of sensitizing domains will alert the researcher to listen for a broad range of aspects relevant to their topic. It will tell them where to look, but not what they should see there. Sensitizing categories organize the phenomenon being studied, without constraining it. Organizing the data into domains reduces the complexity of the analysis into more workable subsets of data that can be handled one at a time. This means that the researcher is less likely to be overwhelmed by the “buzzing, blooming confusion” of their data.
Exercise: Spend half an hour thinking about a research topic you are interested in. What specifically do you want to know about it? What are its aspects or phases? Is it something that happens in a single moment, or does it unfold gradually over time? Does it have a beginning, middle and an end? See if you can produce an initial set of headings to organize your topic. Try to write one or two interview questions for each heading.


Bogdan, R., & Taylor, S.J. (1975). Introduction to qualitative research methods. New York: Wiley.

Elliott, R. & Timulak, L. (2005). Descriptive and interpretive approaches to qualitative research. In J. Miles & P. Gilbert (eds.), A Handbook of Research Methods in Clinical and Health Psychology (147-159). Oxford, UK: Oxford University Press.

Garfinkel, H. (1967). Studies in ethnomethodology. Englewood Cliffs, NJ: Prentice-Hall.

Glaser, B. G. (1978). Theoretical sensitivity. Mill Valley, CA: Sociology Press.

Glaser, B. G. & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine.

Husserl, E. (1913/1982). Ideas pertaining to a pure phenomenology and to a phenomenological philosophy: General introduction to a pure phenomenology (trans. F. Kersten). Boston: Kluwer.

James, W. (1890/1981). Principles of psychology. Cambridge, MA: Harvard University Press, 1981.

Rhodes, R.H., Hill, C.E., Thompson, B.J., & Elliott, R. (1994). Client retrospective recall of resolved and unresolved misunderstanding events. Journal of Counseling Psychology, 41, 473-483.

Wikipedia. Grounded theory (Glaser). Retrieved on 12 Nov 2008 at:

Saturday, November 08, 2008

HPCE Expert Reference Group – Part 6

Entry for 7 November 2008:

In the continuing saga of the Humanistic-Person-Centred-Experiential (HPCE) therapy competences expert reference group (ERG), we have now reached our sixth meeting. The framework is now being worked on primarily by Andy Hill and Tony Roth, with input from various of the rest of us on the ERG, plus a working group at UKCP (UK Council for Psychotherapy). We have worked and reworked the “Generic Therapeutic Competences”. These run across different theoretical orientations with relatively minor variations in language and nuance, such that parallel versions exist for CBT, psychodynamic and family-systemic therapies. These are these are now in fairly good shape, so they got very little of our time today.

Basic Therapeutic Competences. Today’s main agenda item was to review the work that Andy and Tony had done on the next domain in the framework: “Basic Therapeutic Competences”, defined as foundational competences shared and constitutive of HPCE practice. These are really the heart of the HPCE framework. We had done quite a bit of work on these last time, and now had to review and try to finalize them, plus deal with various version control issues stemming from folks having worked off of different evolving version.

At this point, the Basic HPCE Competences are divided into the following outline (this is still not the final version, but should give the flavour):

A. Knowledge of the rationale for HPCE therapy
A1. Knowledge of humanistic principles that inform the therapeutic approach
A2. Knowledge of HPCE theories of human growth and development and the origins of psychological distress
A3. Knowledge of the HPCE conditions for and goals of therapeutic change
B. Ability to initiate therapeutic relationships
B1. Ability to explain and demonstrate the rationale for HPCE to the client
B2. Ability to work with the client to establish a therapeutic aim
C. Ability to maintain and develop therapeutic relationships
C1. Ability to experience and communicate empathy
C2. Ability to experience and to communicate unconditional positive regard for clients
C3. Ability to maintain congruence in the therapeutic relationship
D. Ability to conclude the therapeutic relationship

Under each of these headings are 5 to 20 subheadings, extending up to 3 outline levels deeper, presented in indented boxes, for example, under empathy, Box C1c, currently reads, “An ability to sense and understand those feelings and perceptions of which the client is aware, as well as those which [sic] have not yet entered the client’s awareness.”

A working group of the Humanistic and Integrative Psychotherapies (HIPS) section of UKCP had put a considerable effort into doing up a revision of the Basic Competences; the nature and extent of these proposals was such that several of us had gone into the meeting today worried about the potential for this to derail the whole process. Our fears proved unfounded, however, as Steve, Tony, Janet Tolan (the representative from the British Association for the Person-Centred Approach), and others were able to make creative use of many of these suggestions to improve the emerging product, while remaining true to the evidence base and training manual corpus. Thus, we were able to work efficiently (for us) through the latest version of this domain, and at the end were quite pleased for the progress on this part of the framework.

Metacompetences. One of the thing that came out strongly from the day was the importance of what Tony and Steve are calling “Meta-competences,” that is, competences about how to apply the competences. This is where things like clinical judgment, responsiveness, critical self-reflection, effective use of therapist own experiences, and issues of directivity and nondirectivity all come into play. Many of the really tricky bits fall under this rubric. For example, the key overarching principle in PE-EFT is actually a meta-competence: Balancing relational and task processes, a general issue that appeared in several forms over the course of the day. In fact, much of the input from UKCP about critical reflection and personal integration really speaks to issues that can be nicely handled as metacompetences. Furthermore, it has become clear that there are specific metacompetences distinctive of HPCE, which will be important defining criteria. So this turns out to be a very useful conceptual tool indeed, in a way analogous to regulatory DNA in the genetic code, which is turning out to be at least as important as the traditional kind of DNA, in that it turns the latter on and off.

Onward to the Specific HPCE Methods Domain. Before finishing up, we turned briefly to the next domain, Specific HPCE Methods, more to scope out the next steps than anything else. After some discussion, we clarified that this domain should address therapeutic methods common to many but not all (or even most) HPCE therapists. This means that there can be things here that various folks never use and might not even approve of, which allows the framework the capture important variations in practice, without their being imposed on those who don't want them.

Much of this section as it currently stands is derived from the two PE-EFT texts we’re using, Learning emotion-focused therapy (Elliott et al., 2004) and Emotion-focused therapy for depression (Greenberg & Watson, 2006). What isn’t clear yet is whether this will be the realm of the experiential branch of HPCE family only, or whether we will be able to find something useful in it for therapists from the classical/relational person-centred branch.

This section is also particularly important for the HIPS folks from UKCP, many but not all of whom belong to the experiential branch of the HPCE family. This is where their use of enactments (chairwork), re-experiencing, and focusing/awareness methods will be able to find a place. Fortunately, PE-EFF is an instance of an integrative humanistic therapy that has a systematic theoretical and practice framework, but also has the RCT evidence and detailed therapy manuals needed for the competence development process. This allows much of HIPS a road into the HPCE competence framework.

The issue of how to bring into this the classical-relational branch of HPCE is a more difficult question. After some discussion, we decided to see if we could broaden the entries in this domain, to make at least some of it more relevant to a wider range HPCE therapists of classical and nonclassical persuasions.

Translating PE-EFT into Classical PCT. This is actually something close to my heart at the moment, as I have recently been trying find ways to talk about PE-EFT concepts to more traditional students and colleagues. For example, I want to talk with classical-relational person-centred therapists about how they understand and work with conflict splits in a more traditional way, using empathic exploration rather than chair enactments. This is because for me working on the right task (for this client at this moment) more important than the particular methods used to work on that task. If you’re working on the wrong task (that doesn’t fit where the client is at the moment), then it doesn’t matter what you do; you’re still going to be at cross purposes with the client. But if you are at least going in the same direction as the client, it means that you are less likely to get in their way!

The result of our discussion today was that we appointed me to work with Andy and Tony to put in some further effort on the working with emotion section of the Specific Methods domain. This should be an interesting challenge…

Dialectical constructivist reflections. As the meeting broke up, it was 4pm on a Friday afternoon in London, darkening already in the early November dusk, but also I felt darkened by the deepening economic recession (I wondered if that was why the train to London was surprisingly empty). Mick and I stayed and chatted with Tony and Steve for a few minutes before heading off. I think it’s been a good journey so far, and the dialogue with them and with Vanja representing something of the humanistic-integrative position was been both educational and useful for all of us. I think we’ve all learned from each other, and over the months I think I’ve detected a rising respect for all this humanistic therapy stuff from Steve and Tony, or at least less bemusement and scepticism. At the same time, I’ve come to respect what they’re about on this project of developing all these different competence frameworks. What looked like it might turn out to be a cookie cutter process has turned into something much more subtle. In piagetian terms, there has been both accommodation and assimilation: We have changed and so have they, their views and even the general competence framework itself evolving out of the process. I was reminded of my friend Bill Stiles’ theory-developing case study research on the Assimilation Model, morphing and adapting as it encounters new data and new problems. In PE-EFT and Gestalt therapy terms, we’d say it has been a dialectically constructive process in which different processes were differentiated or separated, then brought back into contact, something that we believe is fundamental to the process of change, producing newness that is never predictable in advance, but which makes logical sense afterwards.

Wednesday, November 05, 2008

Workshop in Belfast on the Day after the American Election

Entry for 4 November:

Months ago I agreed to cover the Belfast one-day workshop in our ESRC-funded grant project on developing research training capacity in counselling trainers. This was originally intended as a feeder for our five-day summer school program, but the Belfast workshop got scheduled after the summer school, so now it’s a feeder for a possible 2009 summer school.

Rather than attempt the whole thing in one day, I flew in last night, election day in the US. Diane and I had voted weeks ago by absentee ballot, so it was all over but the waiting for us. It was an eerie feeling, flying into a foreign city on election night, temporarily homeless. At some point, I remembered sitting in the Lodi Public Library on election night in 1960, waiting for my dad to finish up at the office and pick me up to take me home, filled with a sense of lonely dislocation, as large historical forces ground themselves into a new alignment, marking the beginning of a new era. Last night, this impression was rendered stronger by the fact that I am in the midst of a very bad cold, hacking, coughing and congested.

I had dinner with Jean McMinn, a faculty member on the counselling course at Queens University in Belfast; she had asked for the opportunity to pick my brain about what might be entailed in their setting up a new research clinic in the School of Education. I was happy to do this, and in spite of feeling unwell, it was a most interesting evening, as she spoke of the legacy of The Troubles, the long civil war in Northern Ireland, that is still too toxic to discuss openly when counsellor and client are unsure of each other’s position before the ceasefire 13 years ago (“How would my therapist feel if she knew that I was an IRA supporter?”).

My cough made it difficult to sleep, and the unfolding drama of the election returns proved to be too big a temptation for me to resist; I got up and checked the news at 1:30am GMT (8:30pm in Ohio) and again at 3:30am, watching the fascination of British television with this historic election. I was watching at 4am, as the polls closed on the west coast, they called the election for Obama, and at 4:30 when McCain gracefully and movingly conceded the election. I felt deeply moved, to tears, as I watched the crowds in Chicago and New York City, gathered mark the occasion and to celebrate. One of the many factors in our move to Scotland was our embarrassment at being associated with a country with such an inept, narrow-minded administration, which we saw as moving us all rapidly toward becoming a police state, and which was elected to office by the American people, including our neighbors in Toledo, not just once but twice. As I watched, I felt the beginning of a deep tectonic reversal, and even felt a bit of hope and pride that just maybe we had finally gotten something right.

This morning I got up, somewhat worse for the wear, and met Kaye Richards in the lobby for the walk over to the Queens University School of Education. We had 14 attendees, a varied lot including local counselling course faculty, some folks up from Trinity College Dublin (Laco’s haunt), a couple of nervous CBT therapists fearing ostracism, and several others. On reviewing their hopes and fears (a standard ritual in counselling training events in the UK), it quickly became obvious that we were never going approach being able to meet the needs this diverse but fascinating group.

We resigned ourselves to being as entertaining as possible: Kaye balanced on her high heels while she outlined the context of the RDI project and BACP’s proposed Core Curriculum; I turned John McLeod’s potted tour of the history of psychotherapy research into breathless race through the main research findings from thousands of research studies, alternating passion and cynicism, while shamelessly plugging Mick’s new book; we dropped the canned voice-over powerpoint presentation on evaluation research in favour of an extended version of my outcome monitoring/stealth quantitative input; we allayed the CBT therapists' fears by providing them the opportunity to be heard and respected; and we ended up helping the group think about setting up their own Northern Ireland Counselling Research Google Group. In between, there was the now-familiar ritual of attendees coming up to us to ask us about their research ideas. Before leaving, I met for a bit with Jean and her head of school, Tony, to discuss ideas about the possible Queens University research clinic.

On the hour-long way back to the airport (I’d made the mistake of flying into Belfast International Airport rather than Belfast City Airport), I had a long talk with the taxi driver, a Belfast native, about the election and what it might mean for the US and the rest of the world. It’s not clear to me from this distance whether Americans are really aware of the extent to which the rest of the world has been waiting with bated breath for this outcome, but it’s really true, and now it appears that there is widespread hope that things will be different and that the US will once again collaborate with other countries rather try to bully or go it alone. I’m almost afraid to hope, but what else is there?

As I walked back up the hill from the Hyndland train station tonight, I heard the distant pop-pop of fireworks, marking Bonfire Night (AKA Guy Fawkes Day), and it made me think in contrast of Northern Ireland, just emerging from The Troubles. No need there to celebrate an ancient attempt to incite civil war; the real thing is still too raw and close. America’s celebration of new hope seems more appropriate to me tonight.

Sunday, November 02, 2008

Grace and Music at St. Mary’s

Entry for 1 November 2008, All Saints Day:

A year and a half ago I attended a moving concert/service of church music at St. Mary’s, featuring music by John Bell and James McMillan. Tonight, for All Saints’ Day, at the turning of another season in the Celtic calendar, there was another such ecumenical event, featuring the same musicians. This time it was further enhanced by an art exhibition of pieces by 25 artists who had been invited to submit work on the theme of grace. These paintings and other artworks contributed an appropriate backdrop to a concert of music of varying colours, ranging from painful longing (McMillan’s “Kiss on Wood”) to joyous (“Sing for God’s Glory” by Kathy Galloway).

Our own experience of grace was deepened by our having taken along with us Carmen Mateu, a colleague from Spain who is doing a 4-month sabbatical here at the Counselling Unit. Carmen is fun to have along, because she experiences most things in a rather intense, enthusiastic manner, savouring the joy and sorrow of each moment. She was particularly taken by John Bell’s red shoes and his skill in leading congregation singing (he is a master at the latter. However, the piece that is still in my head is James McMillan’s instrumental meditation on the crucifixion, “Kiss on Wood”, for Violin and Piano, performed by grace-ful coincidence in front of what was probably the most powerful painting in the exhibition, a piece depicting four men dressed in modern clothing (one in a suit and tie), helping carry a large wood cross. For some reason, the tone and mood, the McMillan’s haunting piece reminded me of deconstructed version of Portuguese composer Carlos Paredes’ fado-inspired “Verdes Anos” ("Green years"), particularly in the Kronos Quartet version. A Google search turned up a recording of a performance of the McMillan composition on YouTube: .

Other high points of the concert: The song “There is a line of women”, honouring the women of the Bible, which Carmen and Diane also particularly liked (and which my mom would have loved); “Ipharadisi” a simple South African song of remembrance (“Ipharadisi, where all the dead are living/ may we one day join them all there”); and “For all the saints” (music by Vaughan Williams to words by William Walsham How), one of my all-time favourite hymns, which we played at my dad’s memorial service. Like the previous concert, the music here found a connection to my dad. We went home with hearts full of grace, fellowship, and wonder.

Wednesday, October 22, 2008

Research Clinic Marks 100th Client

Entry for 21 October 2008:

This afternoon Brian proudly announced that research clinic had logged its 100th client: Since its first client contact last November, the Strathclyde Centre for Counselling & Psychotherapy has been contacted by 100 prospective clients.

Almost all of these clients have received telephone screenings; most have received intake screenings in one of our two research protocols; dozens have begun counselling; and a growing number have finished counselling. We now have a waiting list, which is a mixed blessing, but indicates the research clinic is clearly meeting a community need. We have logged several hundred sessions and sponsored three masters level dissertations by Counselling Psychology students (HSCED studies). As well as providing valuable training and practice opportunities for students and professional-level counsellors, as well as mental health services for folks from the Glasgow area, the research clinic is a research collective: That is, students and professionals contribute data as counsellors and researchers, and can then draw on the data set for their own research. As the the data archive builds, a wider variety of research projects becomes possible.

We are now interviewing the second cohort of students seeking placements in the research clinic. We are looking forward to seeing our 2nd hundred clients!

For more information, see the research clinic’s website:

Sunday, October 19, 2008

The Hermeneutic Circle

Entry for 19 Oct 2008:

Note. Some time ago I was asked to write a short piece on the Hermeneutic Circle for a research website at the University of Strathclyde. After putting it off for far too long, I decided I’d try it out as a blog entry. For the past 2 weeks, it has absorbed almost all my blogging energy, but I finally finished it this weekend.

Students in research methods courses often find the word “hermeneutic” and the associated concept of the Hermeneutic Circle to be intimidating pieces of technical philosophical/research jargon. For that reason, it is worth trying to unpack and demystify these concepts.


The word “hermeneutic” is really just a technical word for interpretation, but not necessarily interpretation in the psychoanalytic sense of interpreting unconscious phenomena. Instead, by focusing on how we make sense of complicated texts, hermeneutics brings our attention to one of the central issues in human existence: how it is possible for us to understand one another at all.

Although its etymology is obscure, it appears to be related to the Greek messenger god Hermes, who provides a handy metaphor for the act of interpretation, in that he was believed to deliver messages from the gods. In ancient times, important messages, as from one king to another, were delivered in the form of a scroll contained in a carrier tube, sealed with wax and stamped with the king’s signet ring. To receive the message, one would have to break the royal seal, remove the scroll from its concealing tube, and unroll it; all of these physical acts provide metaphors for the process of interpreting a difficult text or utterance.

Although typically traced to 18th century theologian/Bible scholars, the discipline of hermeneutics in fact goes back to the ancient Greek philosopher Aristotle (350 BCE/2007), who wrote a book on the grammatical/logical hermeneutics, commonly referred to by its Latin title, De Interpretatione (“On Interpretation”, in English). Aristotle was of course interested in the interpretation of linguistic statements in general; however, during the medieval and renaissance periods, its main focus was on the interpretation of the Bible (Biblical Hermeneutics), in terms of its multiple levels of meaning. Hermeneutics as systematic discipline became formalized by Friedrich Schleiermacher (1768-1834) and Wilhelm Dilthey (1833-1911) in the 18th and 19th centuries (Ramberg & Gjesdal, 2008).

For Bible scholars such as Friedrich Schleiermacher hermeneutics was the discipline of unpacking the meaning of ancient biblical sources, which are complicated, often damaged texts, dense with meaning of special significance to believers. Modern Bible scholars provide interesting examples of the hermeneutic method applied intensively to a single text over time: For example, Rudolf Bultmann (1884-1976) attempted to separate out the different layers of texts that had been written, revised and added to, over centuries.

Since Schleiermacher, modern hermeneutics has been developed successively by Dilthey, Heidegger, Gadamer, Habermas, and Ricoeur. Eventually, in the 1980’s, as part of the emergence of the qualitative research paradigm, this began to reach mainstream social sciences including psychology, sociology and education. Influential evaluation textbooks, such as early editions of Patton (2001) began to include sections on hermeneutic-interpretive research; Packer and Addison’s Entering the Circle (1989) marked the emergence of interest in hermeneutic methods in psychology. Today, the interpretive-hermeneutic approach is one of the main perspectives on qualitative research, alongside Grounded Theory (e.g., Strauss & Corbin, 1998) and empirical phenomenology (e.g., Wertz, 1983). In spite of superficial differences in intellectual tradition and terminology, the three overlap substantially with one another (McLeod, 2001). For example, Interpretative Phenomenological Analysis (IPA: Smith & Osborn, 2003), as its name suggests, combines elements of hermeneutics and empirical phenomenology.

The Hermeneutic Circle: How is Understanding Possible?

Formulation of the hermeneutic circle goes back to Spinoza and is the central organizing concept in hermeneutics (Ramberg & Gjesdal, 2008), serving as key metaphor, narrative, paradox or puzzle: In encountering a text, especially a dense, complex text, our understanding of each part is based on our understanding of the whole, including its personal and cultural context; and yet we can only build up our understanding of the whole (and its context) by understanding the different parts of which the text is constructed. Initially, our understanding of the whole is made up entirely of a “forestructure” of the expectations or pre-understandings that we have brought to our encounter with the text we are trying to understand. Paradoxically, it is these that make understanding possible in the first place; and yet, clearly, these expectations or even prejudices are at the same time the major impediment to truly understanding the text. Furthermore, this paradox is fundamental not only to our understanding of texts, but also our coming to know any novel situation or even other human beings. The hermeneutic circle thus raises the question of how it is possible for human beings to understand one another.

The answer to this puzzle turns out to be repeated careful readings, which means that the hermeneutic circle is really more of spiral, as we circle deeper and deeper into understanding a text, qualitative interview protocol, or another human being. This is because each encounter or reading brings us into contact with new aspects of the text or person, deepening our understanding. Our reading moves tentatively at first in a kind of dialog, back and forth, gradually both deepening and opening up the text or person to us. Although this process is never really complete, it eventually reaches far enough to satisfy our immediate purposes, whether as researchers, or counsellors, or fellow human beings. (refs)

What does this have to do with Research?

Rennie (2000) has proposed that this process applies to all forms of qualitative analysis, even those that claim to be descriptive, and that therefore hermeneutics is the core philosophy of science for qualitative research. It can even be argued that the hermeneutic circle applies as well to the process of developing and refining measures in quantitative research. Thinking hermeneutically encourages us to be aware of the pre-understandings we bring to our research, to read our data carefully and deeply and to circle through it repeatedly in stages of familiarization, unitizing, category construction, linking up aspects of the analysis, and review/self-audit, and writing up. It cautions us to avoid the easy philosophical solutions of either realism or relativism, but instead to step carefully along what Rennie refers to the rocky middle road between the two.

To learn more about hermeneutics and the hermeneutic circle, see the references below.


Aristotle. (350 BCE/2007). On interpretation (Trans. E.A Edgehill). Accessed on 16 October 2008, at

Elliott, R. (1989). Comprehensive Process Analysis: Understanding the change process in significant therapy events. In M. Packer & R.B. Addison (Eds.), Entering the circle: Hermeneutic investigation in psychology (pp. 165-184). Albany, NY: SUNY Press.

Elliott, R. (1993). Carrying out a Comprehensive Process Analysis. Unpublished paper. University of Toledo, Toledo, Ohio USA. [available by request]

McLeod, J. (2001). Qualitative research in counselling and psychotherapy. London, UK: Sage.

Packer, M.J., & Addison, R.B. (Eds.). (1989). Entering the circle: Hermeneutic investigation in psychology. Albany, NY: SUNY Press.

Patton, M.Q. (2001). Qualitative evaluation and research methods (3nd ed.). London, UK: Sage.

Ramberg, B., & Gjesdal, K. (2008). Hermeneutics, in E. N. Zalta (ed.), The Stanford Encyclopedia of Philosophy (Fall 2008 Edition). Accessed on 5 October 2008, at .

Rennie, D.L. (2000). Grounded theory methodology as methodical hermeneutics: Reconciling realism and relativism. Theory & Psychology, 10, 481-502.

Smith, J.A. and Osborn, M. (2003) Interpretative phenomenological analysis. In J.A. Smith (Ed.), Qualitative Psychology: A Practical Guide to Methods. London: Sage.

Wertz, F.J. (1983). From everyday to psychological description: Analyzing the moments of a qualitative data analysis. Journal of Phenomenological Psychology, 14, 197-241.

Saturday, October 18, 2008

Emotion Focused Therapy (EFT) training with Les Greenberg, PhD

Les Greenberg has asked me to let people know about his upcoming EFT training workshops. He certainly keeps himself busy! -Robert

EFT Institutes provide participants with a solid grounding in the skills required to work more directly with emotion in psychotherapy. Participants receive in-depth skills training through a combination of brief lectures, video demonstrations, live modeling, case discussions, and extensive supervised role-playing practice.

Les Greenberg, Ph.D. is a Professor of Psychology at York University. He is the Founder of Emotion Focused Therapy and the Director of the York University Psychotherapy Research Center.

The Applied Psychology Institute is approved by the Canadian Psychological Association to offer continuing education for psychologists. API maintains responsibility for all programs.

Couples EFT Institute, Level I
November 9-12, 2008 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario

Individual EFT Institute, Level I
August 10-13, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, ON

Individual EFT Institute, Level II (option #1)
October 21-24, 2008 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario

Individual EFT Institute, Level II (option #2)
February 23-26, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Palm Desert, California

Individual EFT Institute, Level II (option #3)
August 17-20, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, ON
Individual EFT Institute, Level III
October 2-4, 2009 (18 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario

See <> for registration details.
Leslie S. Greenberg
Professor, Dept. of Psychology
York University
4700 Keele St. Toronto, ON, Canada M3J 1P3
Phone (416) 736-5115 x66111
Fax (416) 736-5814

Saturday, October 11, 2008

Mitchell Library

Entry for 11 October 2008:

Today was a lovely, though cool, day in Glasgow. After a heavy week of teaching and rain, it was a relief to be able to get up this morning and do a 10-mile run along the canals in the morning sunshine. For this week's Saturday Adventure, Diane and I visited the Mitchell Library, an imposing structure on edge of the city Centre, which we’d walked past many times without going in. We spent most of our time in then Glasgow Collection, a room full of a really nice collection of books, graphics, maps etc on Glasgow, among their other collections. In an obscure corner of the Library we stumbled upon a room full of the most marvellous puppets from all over the world, piled cheek by jowl next to each other. Magical! A return visit will make a lovely outing for some future rainy Saturday.

Tuesday, September 30, 2008

New Litany for Running

Entry for 27 September 2008:

While I‘m out running, I have a little litany or prayer that I have been doing for many years (since about the time I turned 50, actually). The basic form starts like this:
Lady of the Universe,
You hold all things in your hands,
You hold each of us in your hands;
I ask you to hold ____ in your hands.
In the blank, I insert the name of various people for whom I have some concern: a family member, a client, a colleague, one of my children, and usually myself. I then imagine this person surrounded by light.

Then I continue with the second part, which I usually reach in the last few minutes of my run:
Lady of the Universe,
I don’t know where I came from before I was born,
And I don’t know what will happen to me when I die.
As far as I know, I come from nothing,
And when I die, I go to nothing.

Therefore, every moment is a gift,
every day is a gift,
every month is a gift,
every year is a gift,
and my life, my ___ years are gift.
Over the years, this little litany has helped me face and acknowledge my fear of death, which has largely dissolved in the face of this “radical acceptance” (to use Ann Weiser Cornell’s memorable phrase).

However, in past few years, the meaning of the “I” in “I don’t know where I came from, etc” has shifted to something closer to: “the small, limited part of me that calls itself ‘I’ die”. And usually when I get to this part of the litany, something in me answers back that it doesn’t really buy this anymore.

This is because this something in me has really come to believe something closer to:
Lady of the Universe,
I know that I come out of all that has gone before me,
And that all this continues to live in me,
In the same way that I will still continue to live,
as part of the pattern everything around me,
Living in all those I’ve known
and touched in some way.

This is the gift of this day, this moment,
this year and this life,
and is to be treasured and rejoiced in … forever.
This is what feels true to me know, and what gives me a sense of peace and acceptance. So last Saturday, coming back from a long, nearly 8-mile run, on a lovely late September Glasgow morning, I decided that it is time for a new version of my Running Litany, along the lines suggested. I’m not sure I’ve got the words exactly right, but it’s a start, which I plan to try out over the next couple of weeks.