Saturday, April 05, 2008

Humanistic-Person-Centred-Experiential Therapy Expert Reference Group Meeting in London

Entry for 30 March 2008:

On Friday week before last a colleague and I flew down to London for the second installment of the expert reference group on what I will call for now “our kind of therapies”. This was the first official meeting, since the previous meeting at the end of January, which I previously described in this blog. At that time, after much discussion, the name we came up with was “Person-centred/Experiential”. When word of this particular branding reached the Humanistic and Integrative Psychotherapies Section (HIPS) of the UKCP (the UK Council of Psychotherapies), various people were most unhappy, resulting in my being grilled by Roger Cleminson at the UKCP Research Conference I presented at in early February. Then, a few days before the expert reference group meeting, we received a communication, from Vanja Orlans and Maria Gilbert from the Metanoia Institute in London, on behalf of UKCP, strongly objecting to our branding as too restrictive.

London City Airport. Our early morning flight into London City Airport, in East London ended with a harrowing, bumpy landing on its tiny runaway right next to the Thames. After we had braked to the stop just short of going into the river, our plane did a 180 degree turned and taxied briskly back along the runaway until we turned in to our gate, grateful that no one had decided to land on top of us.

Following Others onto the Train. After this nerve wracking but whacky arrival, we came out of the gate area into the terminal, whereupon my colleague started running for the escalator. I followed at pace, chasing after him onto what looked like an inter-terminal shuttle train, as is common in US airports. However, as soon as the doors had shut behind us and the trained started off, I looked up to see a sign saying that there was a £50 fine for travelling without a ticket on the train – now revealed to be the new Docklands Light Rail service. When I pointed this out to my colleague, he indicated that he thought I was over-reacting (a view apparently shared by the others at our later meeting at University College London); nevertheless, I wasn't comfortable with the situation and got off at the next stop to purchase a ticket, while he went on without me. (Ironically, when I got down to the ticket gate and saw the Oyster point, I realized that I had been legal after all, by virtue of my Oyster card.)

This incident has subsequently become a metaphor for me. Since I arrived at Strathclyde 18 months ago, I have following other people onto several trains: The Counselling Diploma course, the MSc course, the Social Anxiety project, chairing the Management Team, and most tellingly, the new Counselling Psychology course, whose research supervision load I have finally realized is totally unsustainable for me. Some of these and other trains are good ones for, for which I have the appropriate resources (tickets); others are not. From now on, I resolved, I will need to judge the nature and amount of work that I am going to take on.

Expert reference Group. So we arrived at the meeting on Friday morning to find that Vanja Orlans had been added to the Expert Reference Group (ERG), along with my old friend Germain Lietaer from KU Leuven in Belgium, and Andy Hill and Alison Brettle, the two folks who are going to go through the therapy manuals and extract the competencies.

Tony started by reviewing the process of the ERG for the newcomers, then we launched in the Matter of the Name: Vanja presented UKCP’s position, that “Person-Centred/Experiential” is too narrow and excludes most of her constituents, roughly 2500 therapists in the Humanistic and Integrative section of UKCP, including Gestalt therapists. Vanja had a difficult task, joining a group that had already started, in order to change its direction. She presented her case with some grace and passion. Finally, compromises were proposed and after much discussion we agreed to “Humanistic-Person-Centred-Experiential” therapy, a somewhat inelegant but practical compromise.

A Chainsaw for Stiles et al. After lunch, we, or rather Steve Pilling ran through my scoping document, organizing therapies for different client groups characterized by 2 or more controlled studies with something like a manual. The result was not pretty; it felt like Steve was a chainsaw cutting through the literature that Beth and I had been collecting. He casually dismissed the two enormous Stiles et al. studies, which I had characterized as “RCT equivalents”, using David Clarke’s argument that the data were too selective. That is, he claimed that therapists had selected their best outcome cases to submit, as if this was an established fact about the studies and as if this would somehow explain the lack of any differences among the person-centred, psychodynamic and CBt therapists in these studies. Apparently in his reference group this is what is considered to be reality, in spite of the fact that it would require an unparsimonous collection of factors operating differentially among the different groups of therapists. Apparently, they believe -- without any proof whatsoever -- that the CBT therapists submitted all their cases, while the person-centred therapists only submitted their successes! This is the kind of logic that in my experience follows from an unfalsifiable conviction that one's opinion must be correct, even in the face of contradictory evidence.

Steve and Tony admitted at lunch that RCT-associated therapy manuals are not really fit for purpose for identifying change processes; they indicated that this is a piece of methodological sloppiness that they are willing to live with, for the sake of being able to use the RCT data. Interestingly, a week later, at BPS in Dublin, Tony did admit that this logic is a “sleight of hand”, apparently hoping to charm the audience into buying the trick by coyly admitting to it. Hmm… this certainly sounds like a double standard to me. Accepting Stiles et al., as equivalent to an RCT seems like a lot less of a stretch than using therapy manuals used in RCTs as evidence for change processes.

The upshot of the application of Steve's chainsaw to the data set was not pretty. Nevertheless, Person-centred and PE-EFT were admitted to the list for extracting competencies from therapy manuals, for clients generally, but not for specific client problems. Again, I thought that this was weird, because of the PE-EFT depression evidence and also for having been recognized by the APA Division 12 Task Force. And they wouldn’t buy PE-EFT for trauma, because it wasn’t focused on PTSD. Catherine, our carer advocate on the ERG was most unhappy that Pre-therapy wasn’t admitted, but we will keep trying to find a way to include it with Person-Centred therapy. Gestalt was left up in the air, and really needs Beth and I to dig up some more RCTs.

Nevertheless, in spite of the less than satisfying handling of several clusters, we all ended up feeling as if we had made real progress over the day’s discussions, and that we had a basis for going forward.

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