Saturday, March 22, 2008

Good Friday Moon

Entry for 21 March 2008:

This year Easter falls pretty early, on the 23 March. The earliest it can be is 22 March, defined roughly (but not exactly) as the first Sunday after the first full moon after 20 March, which is an approximation for the vernal equinox (autumnal equinox in the southern hemisphere). It just so happens that the vernal equinox was on the 20th this year, with the full moon given as falling on the 22nd, so equinox and Easter are pretty close together this year.

This feels appropriate to me, because Easter is in many ways a festival of new life (all the pagan symbols of eggs & rabbits). However, putting the equinox together with Easter can make for a cold holiday, with another 6 inches of snow in Ohio, snow in the Scottish highlands, and a cold, clear, windy night for us here in Glasgow. It was brisk as I walked quickly to and from the Good Friday Tenebrae service at St. Mary’s. On the way home, the already-full moon had risen, gleaming in night sky.

Between travelling and clients, I’d managed to miss Palm Sunday and Maundy Thursday, so Tenebrae was where I joined the Holy Week process. Tenebrae is an ancient Good Friday/Holy Saturday service, organized around the ritual extinguishing of candles. At St. Mary’s it turned out to be an hour of anguish, really exploring the felt impact of the Crucifixion, too late even for the narrative to distract from the pain of the loss. I came to the service after a day on my own (Diane is still in the US, and about to leave for Chile for her exchange student sister’s wedding), working; so I was distracted and had some trouble focusing.

This version of the Tenebrae consisted mostly of psalms sung by the choir interspersed with short responses and collects. At the entrance to the choir area of the church, by the rood screen, there were a bunch of candles lit (I didn’t count them, but by tradition it is 13). During the psalms, Kelvin, the priest, would extinguish one or two candles, and a little tendril of smoke would rise, so that by the end all the candles had been put out.

Then Kelvin went to the back of the church and brought forward one small lit candle, which he carried up to the front and placed on the pulpit, anticipating Easter. (At our church Toledo, this candle was placed behind the altar, where its light flickered eerily against the back of the sanctuary.) This is supposed to symbolize and anticipate the Resurrection but somehow this time it felt a bit like cheating, as if we couldn’t stand to be left utterly in darkness. (And of course it would have been more effective if they’d turned off the lights in the church.)

Nevertheless, after the choir had processed out, a sense of emptiness seemed to yawn up, a hollowness at the centre, a real desolation and feeling of absence. It had taken this final emptying out for me to reach this, the emotional point of Good Friday.

As I walked home, under the Easter Moon, I thought about the marking of pain and loss that it seems to me are the point of Good Friday. Why have a holiday to celebrate misery? (T.S. Eliot writes in Little Gidding, “In spite of this, we call this Friday Good.”) For me, its value is really the clear laying out of a key spiritual dialectic, between suffering and joy, separation and reunion, darkness and light, death and life. That is, I think, between the Absence of God that most spiritual persons feel a lot of the time (as far as I can tell), and the comforting Presence of Something that we experience at certain special moments and that we call God. You can’t, it seems to me, have one without the other. Or maybe I should say, you can’t have One with the Other.

Monday, March 17, 2008

Spring Break in Ohio

Entry for 16 March 2008:

Months ago, we promised our kids that we’d spend Spring Break with them this year. This would give us an opportunity to see them between New Years and August, and give Kenneth a place to hang out instead of sitting around Brendan and Mayumi’s apartment playing computer games and getting on their nerves. The timing wasn’t great: I had to back out of the UK-SPR meeting and ended up missing the residential weekend of the Monday Part-time Diploma course. Finally, a major winter storm was forecast to push through Ohio the day of our arrival (again!).

A couple a quick phone calls to Brendan the night before we left resulted in the three of them making a harrowing drive from Cleveland to Toledo on Friday night, ahead the worst of what turned out to be the worst storm of the season. The storm ran pretty much south of Detroit, so just as had happened on our arrival in December, we were able to land in Detroit without difficulty; this time, however, Brendan and Mayumi arrived to pick us up shortly after we came through customs.

Kenneth had shovelled much of the 6 inches of snow from the driveway, providing a path to the front door. After dumping our luggage inside, we went off to our favorite Chinese restaurant, Jing Chuan, arriving about 8:30 on the snowy Saturday evening. There we were welcomed warmly by the owners, who know by now that this is part of our Toledo Re-Entry Ritual. We feasted on spring rolls, Sizzling Rice Soup, Phoenix Chicken (Kenneth’s favorite), Hot Pl ate Beef, and Spicy Shrimp with Vegetables, talking and joking until everyone else had left and we said goodnight to the sleepy staff.

We slept well – minus the hour we lost because of the early daylight-savings time-change (now the first Sunday in March in the US). The next morning we went off for a walk at Wildwood Preserve Metropark, probably Toledo's most beloved municipal park. The storm had passed, so the sun was shining brightly in the clear blue sky, glaring off the new-fallen snow, nearly blinding us on the Prairie Trail. To escape the glare, we followed the boardwalk trail along Ottawa Creek. This was also covered in new snow, which made a particularly satisfying crunching sound as we walked along, the wooden boards reverberating under our feet, almost like the sound corn chips make when you chew them and the sound gets transmitted through your jawbone to your inner ear. The water level of the river was low, but there was ice still clinging to the tree trunks next the path, a foot above the current water level, indicating that the water had been much higher in the not-too-distant past.

Variations of that crunching sound returned over the next few days like music leitmotif: The next day there was a partial thaw, followed by a hard freeze, so that when I went out for a run on Tuesday morning, I heard the sharp crunch of stiff rubber car tires seeking traction on the uneven ice. Then I noticed the more muted crunch of my running shoes breaking through the crust of ice over the snow in the little park near the elementary school my kids used to go. I also bought corn chips and used them to extend my experience of crunchiness. I meditated on the nature of crunchiness and thought about writing a poem about these experiences. (Instead, it came out as a blog.)

The week passed quickly: We discovered that the State of Ohio still thought we owed it income tax on my UK income (as if it wasn’t already taxed at a high enough rate!), threatening us with a financial crunch. We faced an information crunch when we discovered various key documents needed for our US taxes missing. Then we saw our accountant and talked to our lawyer, who reassured us and got us somewhat calmed down. After this, we went back to Cleveland (still piled high with 15 inches of snow) for a day and a half, where we hung out with our kids and explored the Cuyahoga National Park south of Cleveland, lovely in its winter state. In addition, we caught up with some of our friends (but ran out of time and energy for the rest), took stock of where we are with our whole process… and suddenly it was Friday, and almost time for me to fly back to Scotland.

On Saturday before leaving for the airport, Diane and I decided to have a Toledo Saturday Adventure: First, we returned to Wildwood Metropark. The weather had turned beautiful, with highs in the forties or fifities (5 – 12 celsius), and a major thaw was in progress. The Maumee River was at flood stage at Waterville, 20 miles upriver from Toledo. Ottawa Creek had crested the day before at Wildwood, when Diane and Linda had gone there for a walk, but Diane had forgotten her camera and also wanted me to see the inundation.

I had never seen the water as high as it was, spilling out over the floodplain (that’s why they call it a “flood plain”), only a foot below the boardwalk. The water seemed to have gone everywhere, drowning the trees, whose bark was still wet from the previous day’s crest. The brown water swirled and eddied. Mallard ducks and Canada geese plied the swift waters, calling noisily to each other, their cries echoing over the water. As we walked out to the end of the boardwalk (we decided not to experience the muddy path beyond), we took pictures of the water, and each other. The snow was almost all gone; no more crunches! Instead, our feet echoed, woodenly on the boards, like some sort of water-mounted marimba set to play very low notes. An old gentleman, out for a walk, offered to take our photo and we were happy to accept.

Then, we completed our Adventure with a quick trip back to the Toledo Museum of Art. This is a wonderful, underrated museum, and we spent an hour or two revisiting old favorite paintings, discovering new art we hadn’t seen before, and finally visiting the new Glass Pavillion, which had opened since we moved to Scotland. This turned out to be the highlight of the visit: It is a airy,spacious venue, with glass walls and an amazing collection, much of which we had never seen before, from ancient to quite modern and wacky. I had never been that fond of the old glass exhibit in the main part of the museum, but the new space and lovingly-assembled, exhaustive collection totally wowed both of us. It's not Glasgow by a long shot, but Toledo definitely has its charms!

Sunday, March 16, 2008

New Publication: Dekeyser, Prouty & Elliott (2008) Review of Research on Pre-therapy

Entry for 8 March 2008:

Just out in the latest issue of Person-Centered and Experiential Psychotherapies is a review paper I co-authored on research on Pre-Therapy. This article began its life several years ago in a submission to PCEP by Gary Prouty, but subsequently passed through many transformations and revisions to reach its present form, eventually acquiring my doctoral student Mathias Dekeyser of KU Leuven as first author (it’s a chunk of his dissertation) and me as third author for my role of supervising, consulting, effect-size calculation and helping with the writing.

The Pre-therapy research literature is actually pretty sparse, there turned out to be enough to review. Surprisingly, word of the paper has spread through the Pre-therapy Network and even came up in January when we met Mick, Nancy, Sally and I met in London with Tony Roth, Steve Pilling: Catherine Clarke, the service user/carer representative on the PCE Expert Reference Group had caught wind of the impending publication and used its existence to argue for inclusion of Pre-therapy in the core competency work.

Reference: Dekeyser, M., Prouty, G., & Elliott, R. (2008). Pre-Therapy process and outcome: A review of research instruments and findings. Person-Centered and Experiential Psychotherapies, 7, 37-55.

Abstract: Pre-Therapy employs contact reflections to stimulate contact behavior in persons experiencing psychosis. We offer a review of Pre-Therapy research instruments and findings. The Pre-Therapy Rating Scale (PTRS; Prouty, 1994) and the Evaluation Criterion for the Pre-Therapy Interview (ECPI; Dinacci, 1997) have been the two most frequently used instruments for the assessment of contact behavior. PTRS scores seem more reliable than ECPI scores, but all manuals need revision. Particular attention is needed for the rating of non-verbal behavior. A preliminary evaluation of the structure of the PTRS indicates that it is two-dimensional rather than three-dimensional. The PTRS and the ECPI can be regarded as measures of communicative contact but also as measures of the meaningfulness of communication. Preliminary outcome studies suggest that pre-post and comparative effect sizes of Pre-Therapy are large for communicative contact, but the number of participants in these studies is generally low, as is the number of systematic case studies.

BACP Research Committee Meeting, London

Entry for 8 March 2008:

Years after first sounding me out, I was finally asked last year if I would be willing to be on the British Association for Counselling and Psychotherapy’s Research Committee. Last Monday and Tuesday was my first experience on this committee, which meets once a year in London. On Monday evening, I was pleased to meet up with my friends and SPR colleagues, Bill Stiles and Louis Castonguay (Louis somewhat jet-lagged from having only that morning), as well as my Strathclyde colleague Mick Cooper, plus Sue Wheeler (whom I seem to see every other week these days), Michael King (of King et al., 2000, fame), and the usual BACP suspects: Nancy, Suky, Angela. Andrew Reeves, the new editor of BACP’s research journal, Counselling and Psychotherapy Research, was also there, as were two other new members: Pete Bower and Paul Gilbert.

1. Paul Gilbert. Dinner conversation with Paul Gilbert revealed him to be a charming and entertaining fellow. More importantly, it turns out that he and I have been moving in intersecting orbits for years without fully realizing it: I recently wrote a book chapter for him on qualitative research, but neither of us realized that we shared an interest in emotion theory and emotion-focused change processes. Thinking back I now realize that Paul had written a favourable review of an early book chapter I did with Les and one of Les’ students: Greenberg, Elliott & Foerster (1990). Now, we discovered that we are both doing research on social anxiety. Paul is trained in CBT and is a past president of the BABCP (British Association for Behaviour and Cognitive Psychotherapy), but now regards CBT as a kind of “con” because it has become so syncretistic over the past 20 years. Now he is very involved in what he calls Compassionate Mind Therapy, a Third Generation CBT related to Mindfulness therapy and Acceptance and Commitment Therapy (ACT; Hayes), but based firmly in Buddhism. He has his own version of neuroscience-based Emotion Theory and is doing research on critic and compassionate dialogue processes. He promised to send us articles on what he’s up to and we discussed the possibility of my coming down to Derby to exchange ideas at greater length. This was an excellent contact and felt like a further step on our path of developing dialogue with folks in the CBT world. The world is filled with all manner of interesting things!

2. BACP Research Foundation Priorities. BACP is in the process of setting up a research foundation, so much of our time was taken up with brain storming research priorities for funding possible projects. This process generated a long list of favorite topics by those in attendance:
-Practice to research conversions: feasibility studies in which practitioners who have developed promising therapeutic approaches carry out feasibility studies.
-Research infra-structure: Set-up structures whereby BACP members can contribute to large, web-based data sets.
-Data mining of existing data sets (e.g., the various CORE data sets).
-Large-scale of RCT of a key clinical problem, such as couples counselling for marriage breakdown.
-Intermittent therapy through the life cycle (Nick Cummings idea), tracking clients over multiple therapy episodes.
-Long-term therapeutic management of important recurrent problems, e.g., chronic depression.
-Measurement of client counselling preferences (to support a client choice agenda).
-Counselling for grief to address recent controversies over counselling for normal bereavement (probably an RCT).
-Counselling for the two problems most commonly reported by clients: fatigue and crises.
-Why don’t clients come back? (client drop out).
-Systematic reviews of qualitative research.
-Writing of accessible books on important emerging areas of practice (e.g., counselling in schools).
Afterwards, on a long walk with Louis and Bill, we concluded, as a self-appointed subcommittee of three, that BACP’s Research Foundation really should focus on practice-based research, thus providing a complement to the concentration on RCTs by government funding agencies and appealing more directly to their members.

3. If I ran the zoo, part 2: Actually, separate from whatever the Research Foundation gets up to, I think that the BACP should actively promote practice-based research and therapy outcome monitoring as a benefit of membership. This would make BACP into one giant Practitioner Research Network (PRN). They don’t want to endorse any single outcome measure, which makes sense, but instead they could offer a choice of instruments, including CORE-OM, Psychlops, Personal Questionnaire and possibly the new depression-anxiety measure being pushed by the NHS. Each of these would be administered, scored, and stored online, with weekly progress monitoring automatically provided following Mike Lambert’s signal alarm method. It seems to me that this should be provided free as a benefit of membership to BACP members. As such, it would make possible a huge step toward making counselling/ psychotherapy an evidence-based profession. With more than 30,000 members and research on counselling in voluntary and private practice settings only now beginning, the possibilities are enormous!

Monday, March 10, 2008

March Snow in Scotland

Entry for 3 March 2008:

We awoke this morning to find snow on the cars along our street. After I got warmed up, I went out for an early morning run. The snow had started again, large, wet flakes blowing into my face. There was little or no accumulation on the ground in Hyndland, but as I climbed Clevedon Hill, I could feel it under my feet, and I had to take care descending the steep slope toward the canal.

The snow came and went all morning, at times quite thick, blowing nearly horizontally. It flocked the spruce outside our kitchen window, and generally proved to be a picturesque counterpoint to the warm smell of Diane’s brownies baking in the oven.

Now I’m on the 12.49 out of Glasgow Central, bound for London, and we are passing by white fields and snow covered trees, powdery in the midday sun, already at least 3 inches deep. No doubt Glasgow is still mostly free of snow cover, but out here in the country it’s a different story altogether.

* * *

By Carlisle, the snow is gone, the sun shining on the old city walls, but can still be seen in the distance after we’ve left the town. Now, in Cumbria, the mountains are dusted with white above the green valleys.

Sunday, March 02, 2008

Two Day Intensive EFT Workshop for Counselling Psychology Doctoral Students

Entry for 1 March 2008:

The new Counselling Psychology doctoral course, a joint program delivered by the University of Strathclyde and Glasgow Caledonian University, is in its initial year of existence, the first cohort of students now in their second term. Counselling Psychology courses in the UK are supposed to embrace multiple theoretical orientations. However, it’s OK for them to have a core model: Our course is unique in the UK for having a Person-Centred/Experiential core theoretical model, offered in the first year (out of three).

The students have up until now been focusing primarily on more or less classical person-centred therapy, but the core model encompasses PE-EFT. Last Fall I did an overview PE-EFT theory lecture, and this past Thursday and Friday I ran a two-day intensive workshop consisting of a theory review plus four key PE-EFT tasks: Empathic Exploration, Systematic Evocative Unfolding, Clearing a Space, and Two Chair Work.

This structure (which includes two more 2-hour follow-up sessions in April) emerged out of discussions with the Ewan Gillon and the rest of the Counselling Psych tutor team. Going into it I was somewhat concerned about whether it would really work. Could we get anything meaningful done in 2 days? Would it be just an extended "taster" course? How would the students respond to the experiential nature of the training? Would the space -- which turned out to be in the GCU continuing education centre --work?

In the event, things were not ideal: First, in my haste, I left the handouts at home, and had to ask Diane to schlep down to GCU (on Cowcaddens street, on the northern edge of the city centre) with the hand-outs. Next, we didn’t have adequate break-out space, and had to make do with some of the groups practicing outside in the foyer area, which fortunately was stocked with small clusters of chairs here and there, along with pirating temporarily empty rooms.

I had met the students before but didn’t really know most of them. Over course of the two days, however, I got a good sense of them. Although they are diverse in backgrounds, as a group the state of their therapeutic knowledge is more consistent than is the case for the Level 1 PE-EFT training that we have been running in the summers here. This meant that there were things that they found consistently challenging about what I was offering them: In particular, asking questions and process guiding felt like a real change of gear for them, and they struggled with this over the two days. Even the pace of the empathic work was faster than they were used to, and in general, the whole process seemed more intense, which was anxiety-provoking for them. They felt overwhelmed by trying to pay really close attention to what the client was saying, while also mindfully selecting what to pick up on empathically, monitoring the client’s current process (including the client's sense of safety with what they were talking about), and managing the current task…. Well, we’ve never said that PE-EFT is easy. At first, some of the students found this all too much and so felt paralyzed by it.

When we got to Two Chair Work, on the second day, this experiential load and accompanying anxiety came out in a way that I hadn’t anticipated: In the first practice, most of the students in the therapist role had trouble keeping track of which part of the client was in which chair! I've been doing Two Chair Work for so long that I'd forgotten that this can be tricky! When this happened, it also muddled the person in the client role, causing the exercise to grind to a halt. After thsi, we worked on how to help client and therapist begin with a clear understanding of what the two parts of the split were, via empathic reflection and formulation before starting the task, followed by various task structuring responses along the way. This worked much better, and initial discouragement and overwhelmedness evolved into a sense of accomplishment, as the group went back again and again through the afternoon to practice the task. By the end, one group had “graduated” to three chair work (adding an observer self), while another group successfully managed a transition to Empty Chair Work -- without any input from me! -- and all the groups had managed to help someone in the client role run the process at some point without the wheels falling off. Very impressive!

By 4.30 pm on Friday, they couldn’t absorb anymore, but we were all pleased with how it had gone. So we processed for a while and called it day. I’ll meet with them twice in April for the follow-up sessions, during which we’ll do one session on Empty Chair Work and one supervision-type session on applying PE-EFT tasks with clients. By then, this will have amounted to most of the Level 1 PE-EFT training that we’ve been running in each summer. What then? I suppose if any of them wanted to, they could sign up for the Level 2 training. I guess we’ll talk about that when we get there...