Monday, May 26, 2008

Social Anxiety Research Project – Call for Practitioners and Researchers

An innovative research programme on Person-Centred/Experiential counselling/ psychotherapy for people who suffer from social anxiety difficulties is underway at the Jordanhill campus of the University of Strathclyde. We are currently looking for counsellors, psychotherapists and researchers interested in volunteering to be part of this study over the next year. Participating practitioners would see 1 or 2 clients on a weekly basis for 16 to 20 sessions of therapy in one or both of the two study arms: classical person-centred therapy or process-experiential/emotion-focused therapy. Researchers would be involved in pre-counselling screening interviews, as well as mid and follow-up qualitative interviews.

Research meetings are held every two weeks to discuss the research, to review videos of sessions, and to develop our understanding of how to work effectively with this group of clients. This will be in addition to clinical supervision groups we will offer for actual case work. Training will also be provided in the use of the research tools used in the project, including post-session tracking forms.

Essential Qualities (therapists/counsellors):
• Interest in, or experience of working with Social Anxiety
• Diploma in counselling from a BACP / COSCA accredited course
• Capacity to practice effectively as a person-centred/experiential therapist
• Commitment to participating in research activities
• Availability to work with 1 to 2 clients for up to 20 sessions each
• Able to attend regular research supervision meetings
• Capacity to work as part of a team
• Capacity for self-reflection

Desirable Qualities:
• BACP / COSCA accreditation or equivalent
• Previous experience of conducting research

Clinic Times:

The Research Clinic is open 9am to 8pm Monday to Thursday and 9am to 5pm Friday. We currently have time slots available on Tuesdays (am/pm), Wednesdays (am), Thursdays (am/pm) and Fridays (up to 5pm).

If you are interested in being part of this innovative study, please submit a CV (covering academic background, relevant professional experience, relevant professional development training) along with a covering letter (of about 500-1000 words) describing your relevant interests and background. Applicants will also be invited for an interview.

Contact Details:
Professor Robert Elliott
Strathclyde Centre for Counselling and Psychotherapy
Suite D303 David Stow Building
Counselling Unit, University of Strathclyde
76 Southbrae Drive, Glasgow G12 1PP
Phone: 0141 950 3727

Saturday, May 24, 2008

Emotional Well-being and Disadvantage: Concepts, Methods & Change Process Models

Presentation for University of Strathclyde, Faculty of Education Research Event, 22 May 2008.

Definition of Well-Being
American Heritage Dictionary: The state of being healthy, happy, or prosperous; welfare.
Related concepts:
•Quality of Life
•Life satisfaction

Emotional Well-being and Disadvantage
•Economists define well-being in economic terms
•e.g., use GDP as measure of Well-being
•This essentially defines disadvantage as negative well-being
•cf. social/economic models of psychological dysfunction
•Two-way street: Disadvantage vs. “Downward drift”

Types of Well-being
•Economic prosperity
•Physical well-being: health
•Emotional well-being: happiness
•Spiritual well-being

Relation between Emotional Well-Being and Psychological Dysfunction
•Medical vs. social models of psychological dysfunction
•Positive vs. negative well-being
•Positive: happiness
•Negative: psychological distress
•Relevance of Positive Psychology movement

POMP 4 - Version: February 26, 2003 (US Administration on Aging)

Please answer each question by filling in the blank or checking a box:
1. During the past 30 days, for about how many days have you felt sad, blue,
or depressed?
|__|__| days
2. During the past 30 days, for about how many days have you felt worried,
tense, or anxious?
|__|__| days
3. During the past 30 days, for about how many days have you felt you did not
get enough rest or sleep?
|__|__| days
4. During the past 30 days, for about how many days have you felt very
healthy and full of energy?
|__|__| days
5. In general, how would you describe your emotional well-being?
1 Excellent
2 Very Good
3 Good
4 Fair
5 Poor

Well-Being Measures: CORE-Outcome Measure
Rating Scale: 0 Not at all 1 Only Occasionally 3 Sometimes
4 Often 5 Most or all of the time
4. I have felt OK about myself.
14. I have felt like crying.
17. I have felt overwhelmed by my problems.
31. I have felt optimistic about my future.

What is the relationship between Improvement in Well-being and Other kinds of Change?
Three Phase Model of Psychotherapeutic Change (Howard et al.)
1. Remoralization: Increase in Positive Subjective Well-Being =>
2. Remediation: Decrease in Problems/symptom Distress =>
3. Rehabilitation: Improved Life Functioning (role responsibilities, relationships, work, self-esteem)

Kahneman’s Model of Well-Being (adapted)
•Nobel Prize-winner
1. Context
(a) Economic advantage/disadvantage Û interacts with:
(b) Personal disadvantage/psychological injury (trauma, loss, hassles, stress)
=> allows/constrains:
2. Activities: Use of time (pleasurable vs. unpleasant activities) => activates:
3. Emotions: Positive vs. negative (especially depression, anxiety) => leads to self-reflection on:
4. Life satisfaction (assess by elicited judgements; spontaneous thoughts, including recurrent worries)

Well-Being Model Suggests different ways to intervene:
•Improve economic conditions
•Treat psychological causes: injury or stress (e.g., trauma-focused therapy; stress reduction/self-soothing)
•Change activities (less time doing unpleasant things; more time doing pleasurable things; behavior therapy)
•Treat emotional distress: provide emotional support (e.g., person-centred counselling/therapy: offer empathy, warmth, genuine contact); understand/restructure depression, anxiety (e.g., emotion-focused therapy); medication
•Restructure self-reflections (e.g., cognitive therapy; positive thinking)

EFT Level 1 Training in Ireland: The Primacy of Emotion Work

Entry for 19 May 2008:

I’ve just finished 3 intense weeks of travel and presentations and want to look back at what has been happening.

Beginning with the week of 28 April, I flew to Dublin, and Laco and I took the train to Galway, in the west of Ireland, to help Les Greenberg and Serine Warwar run a 4-day level 1 training in Emotion-Focused Therapy. Although this came at a stressful, busy time, it turned out to be quite useful and interesting as an opportunity to see how Les typically runs an EFT Level 1. This was because when Les, Jeanne and I ran the EFT-1 at Strathclyde in 2006, Les made major adjustments to the way he normally runs the training, in both content (e.g., less chairwork) and process (e.g., set times for practice sessions). The EFT-1 that Jeanne and I ran last summer and will do again this coming July was based on the modified version of EFT-1 rather than Les’ usual approach. So it was quite interesting and useful to see how he normally does it.

For one thing, the process had a looser, more fluid feeling: Les adjusted timing and topics as we went, in response to the group. If a practice session was going well, it went longer. A topic might be shifted backwards or forwards. We did Evocative Unfolding after chairwork instead of before it, and this worked out quite nicely. We didn’t worry about covering a wide range of tasks (for example, Self-interruption Splits are covered in Level 2), concentrating on Focusing (the first afternoon), Conflict Split Work (day 2), Empty Chair (day 3), and Evocative Unfolding (day 4). The last afternoon, for dramatic relief, and because people were too exhausted for much else, we looked at videos of cathartic work (beating pillows and hitting chairs with batakas), and we did the pros and cons of this sort of work.

Les also did some nice things to support the group process issues, by allowing participants to self-organize into their own groups (making sure to balance the men, who were in the minority, and to separate siblings and close work associates); he gave them a bit of time to get to know each other at the beginning, and allowed them to stay together through the two days of chairwork and optionally on the last day as well.

He also paid more attention to final processing of the experience and transfer of learning issues. This was done as a useful exercise: Take a few minutes: ask yourself, What am I taking away from this? How would I like to apply it in my practice? What might make it difficult to apply?

The participants, mostly experienced Irish psychologists from the west and south of Ireland who had trained in gestalt therapy, confounded our stereotypes for gestalt therapists by their gentleness and the quality of their empathy. It was a real pleasure to work with them and to see them progress over the 4 days. And it was also a real pleasure to see the ease and flexibility with which Les worked with them. Serine, who had come over from Toronto to help with the training, was also great, in how she worked with the participants, and in her energy, organization, therapeutic skill, humour and enthusiasm.

But the biggest thing was the central focus on emotion, rather than tasks. As my friend Laco points out, the focus of Les' version of the training was on helping the client access core emotions, both maladaptive and adaptive. In other words, the training is emotion-focused rather than task focused. This of course is the difference between EFT and PE, which is really a matter of emphasis. Tasks are important in Les’ version of EFT but they are subordinated to emotion work. Actually, this has always been the case, but in our initial formulation of PE therapy, we emphasized the tasks rather than emotion work. And this feels like a very useful perspective to take back to my work with my PE-EFT students in Scotland, to help them get past the point of being overwhelmed by the complexity of the tasks. Emotions are rich, complex, multi-layered… but there is always the “pain compass” pointing to what is most important to the person at a given moment. This guides us on, like the North Star or a magnetic compass. The tasks are useful maps for helping clients work with emotion, but in the end what is important is the helping our clients access and elaborate their core emotion schemes, and in some cases change some of these with new, more adaptive emotions.

Fiumes Vecchios e Pontes Nuovos: Old Rivers, New Bridges

Entry for 18 May 2008:

Based on my roundtable presentation at the conference La Relazione che Cura: Due Scuole, Due Paradigmi a Confronto [The Relationship that Heals: Two Schools, Two Paradigms in Dialogue], Florence, Italy, May, 2008.

Throughout human history, people have chosen to establish towns along rivers. Florence is one of these. These rivers have then created divisions between the people who live on either bank of these rivers. Often, these divisions have led to envy, prejudice and conflict.

These rivers that divide us are old, familiar ones. In these remarks, I describe some of these rivers. As psychodynamic and person-centred therapists, we have often found ourselves in such a conflicted situation, in which we seem to remain stuck in old, entrenched views of one another, views that over time have become caricatures. However, my main goal is to describe a set of new bridges that can cross these rivers, creating dialogue.

1. Interpretation. The first old dividing river is Intepretation: Is it desirable or not to interpret our clients? On the one hand, those of us who are psychodynamic say yes, this is an important change process, perhaps the most important change process. On the other hand, those of us who are person-centred argue that it is wrong to interpret our clients, because we can’t know the client’s truth and because it disempowers them.

However, it turns out that over time people on both sides of this river have been building toward one anothe. Psychodynamic therapists have described how it is important to offer experience-near interpretations, that move just a little bit into the client’s preconscious, what the client is almost but not quite aware of. And person-centred therapists such as Gendlin and Greenberg and myself have described the most important kind of reflection as one which is at the edge of what the client is aware of, in what Gendlin calls the “unclear felt sense”, using a type of response that Greenberg and Emotion-Focused Therapists call “empathic conjecture”, that is, a guess about what the client may be experiencing, but which they have not yet expressed. Actually, this is not a truly new bridge; it goes back at least to Speisman’s (1959) research and an early paper by Gendlin (I forget the exact reference). This is more a bridge that has fallen into disuse and now needs to be rebuilt and renovated. Let us call this first bridge, the Bridge of Responding at the Edge of the Client’s Awareness. (Or as Carmen [whose last name I’ve forgotten] from the University of Pisa noted afterwards, this corresponds to Vygotsky’s idea of a “zone of proximal development”, which is the idea behind the developmental strategy of “scaffolding”.)

2. Motivation Theory. The second river is Motivation Theory: Drive vs. Actualization. Freud postulated primitive drives toward pleasure as the fundamental motives, while Rogers hypothesized the existence of a basic tendency for people to develop themselves. This division has often been couched in terms such as determinism vs. freedom, or pessimism vs. optimism.

However, as Shlomo Mendelovich so clearly described in his presentation, psychodynamic theory long ago went beyond Freudian Drive Theory to develop first object relations theory and more recently intersubjectivity theory. Meanwhile, on the person-centred side, Gendlin developed the idea of Experiencing as the fundamental human process that organizes perception of the environment and motivates action; subsequently, Greenberg, I, and others have attributed this same function to emotion and emotion schemes. But much of it comes down to what is called object relations or mentalization in contemporary psychodynamic approaches, to the same degree to which psychodynamic intersubjectivity overlaps with classic person-centred concepts like frame of reference, empathy and presence. Together, these two concepts make a kind of neo-Lewinian interpersonal field theory. So the second bridge, having to with motivation theory, can be referred to as the Bridge of Intersubjective Representations.

3. Expertness. The third river that divides us is the vexed issue of Expertness. Historically, psychodynamic therapists have tended to embrace their position as experts on clients’ inner experience, valuing diagnosis, prizing models of psychopathology, and setting out rich case formulations. On the other hand, person-centred therapists have classically prided themselves as “experts in being nonexperts”, endorsing the wisdom of “not-knowing”.

Whereas, in fact, good psychodynamic practice has long involved negotiated meaning, in which therapist and client collaborate to come up with a satisfactory explanation for the client’s problems, while person-centred therapy, in its process-oriented forms, has moved increasingly toward process expertise and the development of specific theories for specific client presenting problems (e.g., PTSD, depression, borderline processes), even coining the term “process diagnosis” (Greenberg). At the very least, as Gianni Sulprizio of the Italian Person-Centred Association noted, person-centred therapists are “expert explorers.” And of course, this process expert – whether psychodynamic or person-centred – encounters a client who is now widely recognized to be an “active self-healer” (as Bohart has proposed). Thus, the third bridge is constructed out of this dialectic: the Bridge Where the Active Self-Healer Meets the Process Expert.

4. Client Population. The fourth river is client population focused upon: more vs. less severe disturbance. Although psychoanalysis initially focused on treating neurotic patients, it soon began extending itself into work on more severe problems, such as psychosis and severe personality problems (e.g., borderline, narcissistic). Also, many psychoanalysts, because of their medical background, worked in hospital settings, and so saw more disturbed people. Person-centred therapy was first developed in college-based counselling clinics in the USA, and for a long time emphasized work with clients in the less disturbed range. While Rogers and his team did undertake a major research study on delivering person-centred therapy to hospitalized patients (the Wisconsin Study), at the time and for several decades afterward, this was regarded as an aberration and a mistake.

In the past 15 years, however, as part of the renaissance of person-centred/experiential psychotherapies, Gary Prouty (Pre-therapy, also known as contact work) and Margaret Warner (fragile process) in particular have pioneered work with more severely disturbed clients, with Prouty’s work now recognized internationally by psychodynamic and other therapists for its relevance to psychotherapeutic work with severely disturbed populations. And of course psychodynamic therapists, like their person-centred brothers and sisters, have always treated large numbers of clients with anxiety and depression. (Note also that it would be a mistake to refer to such neurotic difficulties as “mild”; because these problems often carry a severe illness burden for the person and their significant others.) Thus, I would like to christen the fourth crossing as the Bridge of Human Pain: We are all committed to helping our clients reduce, or manage their pain.

Presumed Biological Foundation. The fifth river dividing the psychodynamic and person-centred approaches can be called their presumed biological foundations: On the one hand, psychodynamic theory, as originally put forward by Freud, used a nineteenth century quasi-biological hydraulic model based on sexual energy; the nature of this psychic energy was broadened over time, but remains an abstract concept not clearly based in contemporary neuroscience. Similarly, person-centred theory postulated a growth or actualization tendency, also highly abstract and not clearly related brain structure or function; and even Gendlin’s concepts of experiencing and the unclear felt sense have not really been adequately integrated into what we have come to learn about the human brain.

Rapidly expanding knowledge from neuroscience is, however, giving us increasingly clearer, more powerful understandings of how our brains develop and change in response to our environments, and in particular how central emotion processes are in our brains. For example, we now know that successful psychotherapy, like other kinds of new experience, is associated with changes in brain structure and function, ranging from increases in the size and efficiency of particular neurons to the creation of new neurons (“neurogenesis”). Furthermore, we have now learned quite a bit about how people use their limbic systems (in the midbrain) to rapidly process sensory information via emotion processes. These brain-based emotion processes involve a level of specificity an order of magnitude greater than the old libido and actualization theories, including separate but overlapping systems dealing with separation/loss-fear/sadness-attachment; novelty-curiosity-exploration; noxiousness-disgust-rejection; danger-fear-avoidance; threat-anger-territoriality; etc. All of these emotion processes integrate brain systems that process perceptual information, memory, emotion, autonomic arousal (body), higher cortical processing (cognition), into effective action. I don’t think that we, as either psychodynamic or person-centred therapists, have yet fully embraced this new knowledge to help us understand how therapy works and how to help our clients more effectively. Thus, I propose a fifth bridge, the Bridge of the Emotional Brain, as a path to further exchange and dialogue.

At the present state of development of our two approaches, I think that the most productive stance is not competition or critique but curiosity, questioning, and dialogue. I don’t think that we are ready to come together into a single integrated position, nor do I even think that this would be useful. Instead, for now, I suspect that the most useful meta-position is going to have to be pluralism, by which I mean the acceptance and appreciation of our differences. We are two peoples, living on either side of a river (or several rivers) than run through human experience; from our respective banks, our positions give us sometimes quite different perspectives, and certainly we have cultivated different perception and resources for helping people. But to be connected by a useful set of bridges that bring us into commerce and dialogue with each other, this seems to be the best place for us to locate ourselves for now.

Wednesday, May 21, 2008

Researching the Relationship that Cures: A Journey of Discovery

Entry for 17 May 2008:

Paper presented at the conference La Relazione che Cura: Due Scuole, Due Paradigmi a Confronto [The Relationship that Heals: Two Schools, Two Paradigms in Dialogue], Florence, Italy, May, 2008.
We shall not cease from exploration,
and the end of all our exploring
will be to arrive where we started
and know the place for the first time.
-T. S. Eliot, Little Gidding
Concept of the Therapeutic Relationship
A. Therapeutic:
• Help-intended
• Evaluated for its beneficial effects on the client
B. Relationship:
•Process, not thing
•Emergent property of what happens between client and therapist
•Can’t be attributed to either client or therapist separately
•Both inner experience and observable interaction
• Defined by both intention and effect

A Century of Research on the Therapeutic Relationship: Landmarks on the Journey
A. Era of Participant Observation Research:
1. Psychoanalysis:
Freud et al.: Transference, collaboration, observing ego
=> Zetzel: therapeutic alliance
=> Greenson: transference; real relationship; therapeutic alliance (bond); working alliance (tasks)

2. Interpersonal theory (Adler, Sullivan, Leary)
Social/group theory (Parsons, Bales): Task vs. socio-emotional functions
British object relations school (Klein, Bion, Fairbairn, Winicott)
=> Attachment theory (Bowlby, Ainsworth); mentalization theory (Fonagy, Bateman)

B. Era of Quantitative Research on the Therapeutic Relationship
3. Rogers/Person-Centred therapy
Recording sessions (1940’s)
=> Measuring therapeutic process: therapist response modes (e.g., reflection of feelings)
=> Rogers’ bold statement: The Process Equation (warmth, empathy, genuineness) => client experiencing => client symptom change
=> Measuring facilitative conditions (observer measures; client self-report measures)
=> Research on facilitative conditions and outcome
=> Widespread dissemination of skill training courses beyond evidence base (1960’s – 1970’s)
=> Counter-reaction against Person-centred view of relationship (late 1970’s to 1990):
• Criticisms: poor research, mixed results, overlapping concepts,
=> Reframed in terms of…

4. Modern era of Psychodynamic relationship research:
•Luborsky: Penn Helping Alliance measures (Alliance types: Type 1: Confidence in therapist expertise (passive); Type 2: Active collaboration by client
=> Other alliance measures: Horowitz et al: California Psychotherapy Alliance Scale (CALPAS); Toronto Alliance Relationship Scales; Agnew Relationship Measure
=> Current dominant formulation: Bordin: Tripartite model of Working Alliance
Bond: emotional connection
Goal agreement (what we are working toward)
Task agreement (what we are doing to reach the goals)
=> Horvath & Greenberg, Working Alliance Inventory (WAI))
•Other alliance concepts:
•Client predisposition: Working Capacity
• Client motivation: Commitment (from agreement?
•Therapist Understanding and Involvement (cf. Rogers’ facilitative conditions)
•Partnership (collaboration)
•Openness (client)
•Initiative (client)

Common Therapeutic Alliance Instruments
1. Working Alliance Inventory (WAI) (36 items; 12 item short form) (Horvath & Greenberg, 1989; Hatcher & Gillaspy, 2006 [12-item revised short form])
•Scale Basis, Points & Time Frame: Frequency; 7 points (revised short form: 5 points)
•Subscales: Bond; Task agreement; Goal agreement;
•Informant: Client, Therapist, Observer
•Non-English Translations: Dutch, Danish, French, Italian

2. California Psychotherapy Alliance Scale (CALPAS; 24 items); (Gaston & Marmar, 1994)
•Scale Basis & Points: Agreement- Disagreement; 6 points
•Subscales: Patient Working Capacity; Patient Commitment; Therapist Understanding and Involvement; Working Strategy Consensus
•Informant: Client, Therapist
•Non-English Translations: French, Portuguese, Italian

3. Penn Helping Alliance Questionnaire-II (Haq-II; 19 items) (Luborsky et al., 1996)
•Scale Basis & Points: Agreement; 7 points
•Subscales: Confidence in Therapist; Active Collaboration
•Informant: Client, Therapist
•Non-English Translations: German, French, Norwegian, Dutch

4. Agnew Relationship Measure (ARM; 28 items; 12- and 5-item short forms) (Agnew-Davies et al., 1998)
•Scale Basis & Points: Agreement, 7 points
•Subscales: Bond, Partnership, Confidence, Openness, Initiative
•Informant: Client, Therapist

5. Positivist view of relationship in Randomized Clinical Trials (RCT):
• Non-specific factor/placebo effect/nuisance variable vs. technique/specific factors:
=> Use of supportive/nondirective relationship control groups in Randomized Clinical Trials
=> Used to establish effectiveness of Cognitive-Behavioral Therapy (CBT)
=> Basis of current “Myth of CBT Superiority” in public health

Results of Quantitative Research on Therapeutic Relationship and Outcome
• Therapeutic Relationship (and its components) is the strongest, most consistent predictor of outcome:
• Therapeutic Alliance: Horvath & Bedi, 2002) meta-analysis of 90 studies: mean r = .21 (weighted by sample size)
• Therapist Empathy: Bohart et al. (2002) meta-analysis of 47 studies: mean r = .32 (weighted)

•Thus, relationship factors appear to account for 4 – 10% of the variance in therapy outcome
• Fairly small effects
• But much larger, more consistent than:
•Technique factors (e.g., interpretation, reflection, two-chair work)
•Type of therapy
•At most: 1% of outcome (Wampold)

Largest predictors of outcome appear to be (Wampold):
1. Client factors (pre-therapy functioning): 40 - 50% of variance
2. Whether you get therapy or not: about 13% of variance
3. Therapist differences (5 - 8% of variance; at least half of this “ Relationship effects)

Unanswered questions:
•What aspects of the relationship are important?
•How does the therapeutic relationship develop?
•How does relationship affect outcome?
•How does relationship interact with other factors?

C. Current Era: Systematic Qualitative Research on Therapeutic Relationship:
6. Emergence of qualitative research on the relationship:
a. Helpful factors research (reviewed by Elliott & James, 1989): Interpersonal, relational factors most frequent helpful factors reported by clients
b. Bachelor (1995): phenomenology of clients’ experience of therapeutic relationship: importance of therapist technique in building relationship

7. Research on Significant Relationship Events
a. Elliott (1985) => Taxonomy of relationship events: Understood, Supported, Close to Therapist, Involved in Therapy => Revised Therapeutic Reactions Scale (RSRS)
b. Timulak (2006) qualitative meta-analysis: Reassurance/Support/Safety (all studies); Feeling Understood (more than half of studies)
c. Bedi, Davis & Williams (2005): Critical Incident Method used to identify factors experienced by clients as contributing to the development of the therapeutic alliance (n=40). The four most common (reported by >30% of clients):
1: Technical activity: Outcome-focused techniques and strategies commonly used by psychotherapists (not including active listening): 72.5%.
• e.g., The therapist taught me a grounding technique.
2: Nonverbal communication: The psychotherapist’s body language (e.g., physical attending skills) and other nonverbal means of communication: 47.5%
• The therapist sat leaning forward in his/her chair.
3: Active listening: The psychotherapist’s active listening skills, including empathic and content-based reflections, summaries, connecting current client material with past client
material, verbal prompts (e.g., “uh-huh”), and silence: 37.5%
• The therapist recognized my feelings and put a name to them when I couldn’t.
4: Choices: The psychotherapist’s presenting and accentuating client choices and conveying that the psychotherapy process is client driven: 32.5%
• The therapist verbally told me I had the choice of whether I would answer anything she/he asked me.
Implication: These recent studies suggest that clients see the therapeutic relationship somewhat differently from current theory:
• Downplay collaboration
• See technical and environmental factors (e.g., therapy room) as important contributors to the therapeutic relationship.
•Distinction between technique and relationship may be a false dichotomy
•Need to look closely at therapy interaction as relationship develops.

Two Views Forward:
1. Quantitative: Advanced Psychometric Methods: Rasch Analysis
Process Experiential Therapeutic Alliance Formation task (Elliott et al., 2004) hypothesized the following sequence of alliance formation with Bordin model:
0. Client drops out before session 1
1. Client physically present
2. Work on trust/bond
3. Work on therapeutic focus
4. Work on goal agreement
5. Work on task agreement
6. Productive working environment
Elliott, Fox et al. (2004) used Rasch analyses of clients’ Working Alliance Inventory ratings to measure the “difficulty” of items
Suggests alternative alliance formation sequence (with some overlap between successive stages):
(1) Absence of misunderstanding
(2) Trust/confidence in therapist
(3) Agreement on general goals/tasks
(4) Experiencing therapist presence
(5) Agreement on practical specifics
(6) Experienced benefits (=early outcome)
2. Intensive look at client-therapist interaction during initial alliance formation:
Example: PE-111-1, Initial Empathy Segment-1 (2:15+)
“George”: 63-year old client with panic and bridge phobia
2:15 into Session 1: follows two previous short segments also devoted to alliance formation
This segment involves establishment of empathic stance with client
C1: … No, it’s this, it’s this, fear, of, of,… getting across bridges of all things
T Settles into inquisitive, intent body position, looking at C, slouched slightly forward. Tilts head slightly to left during silence, as if trying enter client’s experience
T: I see, OK. [soft slightly thin voice]
C1.1 And height, oh my, I have terrible fear of height and it…
T: OK Deep head nods, bobbing upper body.
T1: And it- that interferes with your life? Intent, soft voice; gestures with right hand
C2.1: Oh, it does. We used to take great long road trips, and don’t do any of that any more.
C2.2: Funny thing is, I’m not afraid to fly, as long as it’s a jet plane and it’s multi-engined.
Right hand to mouth, then strong head nods I see.
Shifts head forward, slight nods.
T2: I see, OK, that doesn’t bother you Nodding, intent; soft voice
• Therapeutic relationship generally relates to outcome
• Both therapist and client contribute
• Other factors are also important
• Deepening our understanding of the development, maintenance and repair of therapeutic relationship complex, elusive… and important
• Will require:
• Participant observation by therapists
• Quantitative research relating of therapy process, client experience, and outcome
• Systematic qualitative research on client and therapist experience, significant alliance events, and moment-to-moment process

Tuesday, May 20, 2008

Emotion-Focused Psychotherapy Level 1 Training Summer 2008

Facilitated by Robert Elliott & Jeanne Watson

Monday 30th June – Thursday 3rd July 2008
9.00 – 16.30
Jordanhill Campus
University of Strathclyde

Emotion-Focused Therapy (EFT) is an active, evidence-based, integrative approach to person-centred/experiential therapy, with particular relevance to working with depression, trauma, and anxiety difficulties. One of the most exciting, rapidly developing ‘tribes’ of the person-centred nation, it has gained international recognition through the work of Les Greenberg, Robert Elliott, Jeanne Watson and their colleagues. Thus, the Counselling Unit at the University of Strathclyde is again pleased to offer Level One professional training in this approach to qualified counsellors and psychotherapists (Diploma level or above).

Now in its third year at the University of Strathclyde, this successful, four-day Level One PE-EFT training programme will provide participants with a solid grounding in the skills required to work more directly with emotion in psychotherapy. Participants will receive an in-depth skills training through a combination of brief lectures, video demonstrations, live modelling, case discussions, and extensive supervised role-playing practice. In order to help participants bridge between their person-centred training and the PE-EFT approach, the workshop will begin with a PE-EFT perspective on empathy. It will continue with a discussion of basic principles and the role of emotion and emotional awareness in function and dysfunction. Differential intervention based on process diagnosis will be demonstrated. Videotaped examples of evidence based methods for evoking and exploring emotion schemes, and for dealing with overwhelming emotions, puzzling emotional reactions, painful self-criticism, and emotional injuries from the past will be presented and discussed.

Participants will be trained in the skills of moment-by-moment attunement to affect, and the use of methods of dialoguing with parts or configurations of self and imagined significant others in an empty chair. This training will provide therapists from person-centred and related backgrounds with an opportunity to develop their therapeutic skills and interests.

Educational Objectives
Participants on the training programme will learn:

1. To implement the basic principles of PE-EFT
2. To identify different types of emotional response;
3. When to help clients contain and when to access emotion;
4. How to help clients reprocess difficult emotions;
5. To facilitate emotional processing to resolve self-critical splits and unfinished business.

Programme Outline:
Monday: Foundations, Emotion, Empathy, & Alliance Formation
• Distinctive features of the PE-EFT: neo-humanism & therapeutic principles
• Process-experiential emotion theory: emotion schemes
• Empathic attunement, validation and creating an alliance
• Therapeutic Tasks, Focusing on Feelings, Empathic Exploration
• Emotion response types & emotional change principles • Attachment theory and therapeutic change
• Empathic exploration, evocative empathy, empathic conjecture
• Empathic exploration as a therapeutic task
• Skills practice

Tuesday: Accessing and Managing Emotion
• Therapeutic tasks and process formulation
• Emotion regulation
• Focusing and Clearing a Space
• Skills practice
• Reprocessing Problematic Experiences
• Evocative unfolding, Narrative Retelling, and Meaning Creation
• Skills practice

Wednesday: Active Expression Processes
• Dialectical constructivist models of self
• Two chair dialogue and splits
• Accessing adaptive and problematic emotional responses
• Accessing core problematic emotion schemes
• Skills practice
• Accessing Primary Adaptive Emotions & Restructuring Emotion Schemes
• Empty chair dialogue and unfinished business
• Supporting the emergence of primary needs
• Helping clients use adaptive emotions to challenge core problematic emotion schemes
• Letting go of unmet needs
• Skills practice

Thursday: Identifying Tasks; Empirical support,
• Summary of Research evidence
• Review of tasks; strategies for identifying and selecting tasks
• Skills practice
• Personalized Applications
• Practical parameters
• Depression, Post-traumatic stress difficulties
• Social anxiety
• Borderline processes
• Question & answer period

About the Facilitators

Robert Elliott, Ph.D.
Robert is professor in the Counselling Unit at the University of Strathclyde, where he teachers on the postgraduate diploma and MSc courses in Person-Centred Counselling. He taught at the University of Toledo 1978-2006, where he was Professor of Psychology, Director of Clinical Training and Director of the Center for the Study of Experiential Psychotherapy. He has also been a guest professor at Katholieke Universiteit Leuven, Belgium, University of Sheffield, UK, and La Trobe University, Australia. He is co-author of Facilitating Emotional Change (1993), Learning Emotion-focused Therapy (2004), and Research Methods for Clinical Psychology (2003), as well as more than 100 published scientific articles or book chapters. He is the 2008 recipient of the Carl Rogers Award by the Division of Humanistic Psychology of the American Psychological Association. He is editor emeritus of the journal, Person-Centered Counseling and Psychotherapies and directs the Scottish Consortium for Psychotherapy and Counselling Research and the Strathclyde Centre for Psychotherapy and Counselling Research.

Jeanne Watson, Ph.D.
Jeanne is professor in the Department of Adult Education, Community Development and Counselling Psychology, at OISE at the University of Toronto, Canada. Dr. Watson was the recipient of the Outstanding Early Achievement Award from the Society for Psychotherapy Research in 2001. She has co-authored and edited several books on counselling practice, including Learning Emotion Focused Therapy (2004), Client-Centered and Experiential Psychotherapy in the 21st Century (2002), Handbook of Experiential Psychotherapy, Emotion-focused Therapy for Depression (2005), and most recently Case Studies in Emotion-Focused Therapy for Depression (2007). Jeanne conducts research on empathy, depression and psychotherapy process and outcome in PE-EFT. She conducts workshops in PE-EFT and teaches courses in counselling theory and practice to Masters and Ph.D. students in the postgraduate course in Counselling Psychology at the University of Toronto. Dr. Watson maintains a part-time private practice in Toronto.

Application Information
If you would like to reserve a place on this training course, please complete and return the application form overleaf. Places are strictly limited so book early to avoid disappointment.

The fee for this four-day event is £445. Please note that to keep costs to a minimum, catering is not included in this fee.

For further information on this event, please contact Karen McDairmant, Professional Development Unit on 0141 950 3734 or at

Monday, May 19, 2008

Dancing in Church at Pentecost

Entry for 11 May 2008, Pentecost Sunday:

My first successful experiences of going to dances were all church-related. Our youth group at St. John’s Episcopal Church in Lodi, California, was quite active and put on a dance from time to time, and also travelled together to youth conferences at churches in our part of the Diocese of San Joaquin. These provided me with a safe social situation in which to dance with young women who were my age and whom I had known for a long time; as a result, these dances were important for my social development and really helped me develop confidence. To this day, I still enjoy a good conference dance, if the band is good.

Scotland has a fine tradition of social dancing, called ceilidh (pronounced, “kay-lee”). Scots love to go to ceilidhs, where ceilidh bands play traditional Scottish dance music, for dances such “Gay Gordons” and “Strip the Willow”. The dances are closely related to English country dancing and American square dancing, and are done in lines, circles, groups of six, etc. The dance steps are not too complicated, and are great exercise, leaving the participants out of breath but exhilarated.

Our current church, St. Mary’s Scottish Episcopal Cathedral, in the West End of Glasgow, hosts a ceilidh about once a year. Last year, it was on Easter Day; this year’s ceilidh was held on the evening of Pentecost Sunday, which is the official birthday of the Christian Church. From my point of view, this is a perfect time for a ceilidh, because it is a festival that celebrates the Holy Spirit, and dances in church have always seemed to me to be some sort of expression of that Spirit.

This year, Kenneth came along with us, having arrived in Glasgow only two days before, to spend the summer with us. Kenneth has an excellent sense of rhythm, and has spent years playing the piano and the floormat videogame Dance Dance Revolution, so he joined right in and picked up the dances quickly. The band, called Last Tram tae Auchenshoogle, was quite entertaining, sometimes veering into progressive rock territory, which was musically interesting, if occasionally a wee bit difficult to keep time to. We danced with a wide variety of people whom we knew by sight or slight acquaintance, and by the end of the evening, we had circled around with them, stepped forwards and backwards, looped, clapped and promenaded, and were all somewhat sweaty. It’s a church with a lot of intellectual power, so it was really good to encounter one another in such an embodied manner, dancing to the Holy Spirit, in a grand ceilidh, a Dance of Life.

HSCED as Theory-building Case Study Genre

Entry for 11 May 2008:

Although I have heard Bill Stiles present on theory-building case study research on many occasions, each time I hear something new. At the BACP Research Conference in Cardiff, in his keynote talk, he introduced a nice distinction between Enriching and Theory-building case-study research. Enriching case study research aims to describe and develop explanations/understandings; theory-building case studies use complex case-derived data to create a dialogue with an existing theoretical model, in order to challenge and elaborate it. I have always felt a bit of a disconnect with this idea of starting with a theory, and I suspect that Bill has introduced the idea of an enriching case study to address concerns like mine. However, when I heard this formulation, it had the opposite effect; it propelled me into finally spelling out a sense about the nature of Hermeneutic Single Case Efficacy Design (HSCED) that has been nagging in the back of my mind for some time now:

In fact, HSCED is a theory-building case study genre, with strong parallels to Bill’s Assimilation-model case studies. But what is the theory that is being interrogated and elaborated? In general terms, it is as follows:
• Therapy X causes change in Client Y.

This isn’t much of a theory, which why neither Bill nor I have fully appreciated the theory-building nature of HSCED. However, this general theory actually contains a more elaborate theory, along the following lines:
•Therapy X causes change in Client Y… by Z change processes (=mediating variables), in Q Contexts (=moderator variables, e.g., relevant client characteristics such as resources to make use of the therapy), in R Ways (=specific effects).

This generic version of the theory can then be specified for a given systematic single case study, such as EFT for social anxiety:
1. When Emotion-Focused Therapy is offered
2. To an open, motivated client
3. Who presents with social anxiety,
4. A combination of relationship (warmth, acceptance, genuineness)
5. And task factors (relevant therapeutic tasks such as Empathic Exploration, Anxiety Split work, Self-Soothing work, and Externalization work),
6. Competently and collaboratively delivered,
7. Will provide the client with opportunities to develop better access, express and symbolize their emotional experiences, to regulate their emotions more adequately, and to locate other emotions that can change maladaptive or stuck emotions;
8. This in turn will help the client change problematic behaviours, improve their relationship with themselves and others and become less distressed about their remaining problems.

Wednesday, May 14, 2008

Research Implications of McLeod et al., Clients’ Criteria for Evaluating Outcome

Entry for 10 May 2008:

At the BACP Research Conference, John McLeod, on behalf of the Tayside research clinic team, presented a lovely paper offering preliminary results from his research on client’s experiences of the outcome of their therapy. The three themes that are currently emerging from the qualitative interviews with clients are:
(a) Getting my life back on track: clients came to therapy because their lives had gotten “off track” and had become “stuck”. John pointed out that this is an example of a Journey metaphor (cf. Lakoff & Johnson). I would add that this is also a metaphor of interrupted agency, given that life projects (following Lakoff & Johnson) are typically expressed in terms of the travel (movement through space) metaphor. This in turn makes therapy all about Agency, as David Rennie has been telling us for lo these many years.
(b) Learning something that helped them get unstuck and back on track. John is particularly struck by the importance of learning as a change process for clients. This opens up interfaces with both psychology (my old life) and education (my new life), and reminds me also of Amadeo Giorgi's classic study in phenomenological psychology: the experience of learning something.
(c) Explanation: developing a coherent story of what happened for them in therapy (that is, of how they got unstuck in their lives). In PE-EFT, we would call this a “meaning perspective”.

Not only are these very pretty and persuasive results, they also had some very interesting implications for therapy research:
1. It would be very good idea to develop a measure of “Life Stuckness” (vs. “Life flow” or some such). This reminds me strongly of American pollsters who ask people if the they the US is “on track” or “off track”.
2. It would be a good idea to ask clients to talk about what they have learned over the course of therapy. This isn’t currently in the Change Interview, but it could easily be added to the question about changes, i.e., “What have you learned about yourself in counselling?” and “How have you applied this learning?”
3. It would be a good idea to ask clients, “What is your understanding of what happened in your counselling/therapy?”
These ideas may be worth following through on, particularly if John’s results hold up over further analyses.

Common Validity Threats and Suggested Solutions in Qualitative Research

Entry for 10 May 2008:

Paper presented at BACP Research Conference, Cardiff Bay, May 2008.

Validity Threats in Qualitative Research
• Cook & Campbell, 1979, and others have describe sets of validity threats for experimental studies
• Need similar framework for qualitative research
• Guidelines for reviewing qualitative research (e.g., Elliott, Fischer & Rennie, 1999)
• Here: Start by describing bad practice, then look at potential solutions

1. Closing down Qualitative Investigation from the Beginning
a. Problems:
• Attachment to own expectations or excessive professional socialization in psychology
• Starting with specific hypotheses (closed questions)
• Focusing on closed questions in the interview
• Selecting the data you like from the transcripts, ignoring things that don't fit your expectations
b. Solutions:
• Open up your research questions
• Reflect on your expectations and attachments
• Attempt to bracket your expectations and hopes

2. Qualitative Research Skill Deficits
a. Problems:
• Poor interviewing skills/personal qualities: Listening, empathy, compassion, technical process guiding skills
• Under-developed analytic skills: Empathy, vocabulary, concept formation, access to own experiencing, care/systematicness/ compulsiveness
b. Solutions:
• Practice & training
• Patience
• Switch to quantitative research

3. Methodolatry: Getting Stuck on a Particular Method
a. Problems:
• May not fit you or your topic/questions
• The seductions of brand names (GTA, CQR, IPA)
• Limitations of computer software
• Rigidities of common methods
• Arbitrary sample size requirements (too small or too large)
b. Solution:
• Use generic approach, adapt to own style, topic

4. Carelessness and Impatience
a. Problems:
•Failing to check your results by auditing, checking with informants
• Stopping data collection and analysis before you reach saturation
• Failing to extract rich conceptual structure from your categories (see flat, uninformative results)
• Failing to obtain credibility checks
• Group designs: Not sampling broadly enough to support general knowledge claims
• Single case studies: Not analyzing deeply enough to really understand the person
b. Solutions:
•Manage expectations: good qualitative research is harder (more demanding, time-consuming) than good quantitative research
•Allow enough time & energy to finish and check analyses
•Get adequate academic support

5. Flat, Uninformative Results
a. Problems:
•Often due to “going through the motions” without fully engaging with your data
• Claiming formal domains (topic areas) as substantive results
• The 37-category problem: too many unrelated but overlapping categories
• Giving up on analysis too soon
b. Solutions:
• “Stomach coding” (Rennie)
• Use of narrative structures or organize data
• Use of hierarchies of categories
• Constant comparison and the Rule of Four
• Make a picture or flowchart

6. Presentation Problems
a. Problems (from Elliott, Fischer & Rennie, 1999):
• Not owning your perspective
• Not describing the sample
• Abstract/ungrounded categories
• Disorganized/incoherent categories
• Not presenting the results in rich enough detail to allow readers to evaluate your categories for themselves
b. Solutions:
• Full reporting
• Provide narrative/visual model
• Provide rich case example

Conclusion: Realizing the Potential of Qualitative Research
•Need to reflect carefully at our research practice, make conscious efforts to improve

Sunday, May 11, 2008

BACP Research Conference -- Cardiff 2008

Entry for 10 May 2008:

This year’s BACP Research Conference was in Cardiff, Wales. It’s a nice little conference, only two days, making it manageable, intense, to the point…. and exhausting. I went down a day early, on Wednesday, for the editorial board meeting of Counselling and Psychotherapy Research, BACP’s research journal. I’m writing this on the train back toward Scotland, going up the Severn Bay/River, through the lush countryside, already looking mature and midsummer in its vegetation. It was dark when I passed this way the other direction on Wednesday, so there’s more to see on the way back. If I’m lucky, this train will get to Cheltenham Spa in time for me to connect with the Cross Country train service to Edinburgh, and I’ll make it home sometime after midnight…

1. Qualitative Research Workshop. John McLeod and I got ourselves roped into putting on an opening night function on Thursday night, dealing with problems with qualitative research and how to improve it. This was a fairly informal session, with short presentations by John and me and most of the time devoted to question-and-answer interaction with the audience. When we realized that David Rennie would be there, both of us were somewhat nervous, but fortunately, he didn’t ask us any difficult philosophical questions, and was quite supportive. Then Bill Stiles showed up, jet-lagged from having flown over from the US, making it quite an occasion, as kind of reunion of The Usual Suspects. Beyond David and Bill, there was a good turnout for the session, and many in the audience expressed an interest in an extended summer school on qualitative research, along the lines of a writer’s workshop. I will include the notes for my presentation in a later blog entry.

2. RCTs as cognitive dissonance-inducing strategy. It’s always fun getting together with John, David, and Bill, and we had excellent conversations at various times. Thursday night, after the qualitative research workshop, David, Bill and I sat talking at dinner for a long time, arguing the scientific and political merits of different kinds of research evidence, especially RCTs. I formulated the idea that the common CBT position is based on two seemingly unshakable beliefs: (1) CBT is the most effective therapy; and (2) RCTs are the One True Way to Truth. The only way to effectively challenge these two assumptions, I argued, is to bring them into contradiction with each other; that is, to do RCTs that support the efficacy of a nonCBT therapy! Such a strategy may not be good science, as Bill argued forcefully (a position with which Les Greenberg agreed in our discussions last week in Ireland). However, it does bring the two cherished beliefs of CBT into contradiction, and cognitive dissonance can be a potent force for attitude change.

3. Cardiff Bay. I loved Cardiff Bay, where the conference was located. After a 10-minute walk from the conference hotel, I came upon the Millennium Centre, the new Welsh opera house, nicknamed “the Armadillo” because of the scale-like metal covering its arched back. The first time I looked out my hotel window and saw this structure, a chill ran down my spine, as I recognized it from Torchwood as the place where Captain Jack sometimes stands alone, his long coat furling behind him in the wind off the bay. With a little help from the Wikipedia, I was able to locate the secret entrance to the Hub, the Torchwood team’s base under Roald Dahl Plass: a stone in front of the Watertower Fountain. Numerous photos were taken…

Large areas of formerly run-down waterfront have renovated with modern buildings and hotels, including the new Welsh Assembly building, the front part of which is referred to by locals as “the Flying Nun”, because of its large flat roof, which sports slightly upturned corners, this roof structure charmingly hovering over a large glass-walled ante-chamber to the less flamboyant red brick structure behind it. I was so taken by the wharf area that over the next three days I went back here repeatedly, finally giving Judy Moore a guided tour shortly we caught our taxi to the train station to go home.

4. Clients love weekly outcome assessment. An interesting theme emerged from multiple presentations: Contrary to therapist concerns, client commonly report finding filling out the CORE-Outcome Measure on a weekly basis to be very useful. Gisela Unsworth reported a qualitative study of clients’ experiences of the new on-line CORE-NET weekly outcome service: When asked to identify an animal, bird or flower that reminded them of the CORE-NET process, multiple therapists characterized it as an “elephant”, because of its intrusiveness. Clients, on the other hand, strongly and unanimously endorsed the use of the system to track their change process, several going so far as to say that they believed that all therapies should be monitored in this way. John McLeod reported essentially the same thing for clients seen in the Tayside Clinic in Dundee.

There were several other interesting highlights, some of which will be written up as separate blog entries, but it is worth mentioning for now that: (a) Mick’s keynote on “The Facts Are Friendly” was very nicely done, accessible, and well-received; (b) CPR’s new editor, Andrew Reeves was impressive with his passion and commitment to the BACP journal, as he manages the challenge of balancing this journal’s academic aspirations in the current politico-scientific context with its core value of staying close to practice and its methodological pluralism; and (c) Beth and I managed to produce another iteration of PCE meta-analysis, with ten more studies (and 30 left to go).

Postscript: I finally got home to Glasgow about 12.30 am; Kenneth and Diane were there waiting for me, and we visited until 2 in morning. It'll be really nice to have him with us for the next three months.

Wednesday, May 07, 2008

Article: Research on Client Experiences of Therapy

Entry to 7 May 2008:

From time to time I end up writing an introduction for a special section of Psychotherapy Research. Because of my generally crazy life, these tend to get written at the last minute, under time pressure. And yet, these short pieces are among my favourite articles, because they offer an opportunity to take stock of an area of research. Meerkat-like, I get to stand up on the small hill made by the accumulation of articles on the topic at hand and look to the horizon. Like the sentinel meerkat, I’m not very big and the hill isn’t that high, so I can’t see very far, but it’s farther than the other meerkats can see, and sometimes I have been able to tell what’s coming, which the other meerkats have occasionally found useful.

A year ago, Clara Hill, long-time fellow therapy process researcher and current editor of Psychotherapy Research, asked me to do one of these introduction pieces for a special section of PR on Client Experiences of Psychotherapy. I could hardly say no, because I have spent a substantial part of my research career championing research on this topic, and also because I had published (with Elisabeth James) a qualitative meta-synthesis on client experiences in 1989. In the end, the special section turned out to have six papers, mostly qualitative studies. This provided an opportunity to characterize three current genres of therapy process research:
• Interpersonal Process Recall studies of important therapy events.
• Mental health service evaluation research using qualitative interviews to learn about what clients find helpful or hindering.
• Quantitative survey research evaluating predictors of important therapy processes.
Next, I revived my 1991 Five Dimensional Model of therapy process, the conceptual framework that underlies the Comprehensive Process Analysis method I developed in the 1980’s. This organizes therapy process along five essential dimensions:
• Perspective of observation (client, therapist, observer)
• Person being observed (client, therapist, relationship)
• Unit of process (e.g., speaking turn, session, whole therapy relationship)
• Temporal phase (context, process, consequences)
• Aspect of process (content, action, style, quality)
I used this framework to characterize the six studies, point to commonly studied and overlooked therapy process elements.

Finally, I summarized what could be learned from the six studies, concluding by underscoring the importance of the two Interpersonal Process Recall studies (from the very productive research group of Heidi Levitt at the University of Memphis). It seems to me that these studies point to the importance of studying client agency in the face of therapeutic difficulties (e.g., discovering that you and your therapist don’t see eye to eye on something). I would like to believe that these studies are pointing to an emerging research front that warrants further investigation “to identify a taxonomy of client process difficulties, along with descriptions of common client coping strategies, and lists of therapist responses that can help or hinder clients in resolving these difficulties” p. 242). Such a line of research would complement research on therapist-defined tasks, as developed by Greenberg and Rice, but would focus instead on client-defined tasks.

Reference: Elliott, R. (2008). Research on Client Experiences of Therapy: Introduction to the Special Section. Psychotherapy Research, 18, 239-242.

It turns out that PR is no longer publishing abstracts for introductions to special sections, but the following is the abstract I wrote for this paper:

Abstract: I introduce this special section of research on client experiences of therapy by looking at the six studies reported here from three different angles. First, I summarize each study and characterize it in terms of the current research genres represented. Next, I analyze the studies in terms of the Five Dimensional Model of therapy process (Elliott, 1991). Finally, I briefly summarize what we have learned about the three main questions addressed by these studies: What clients find helpful or hindering in therapy? How do clients see themselves as having changed over the course of therapy?, and, How do clients deal with difficulties in the therapeutic process?

Sunday, May 04, 2008

Article: A Linguistic Phenomenology of Ways of Knowing

Entry for 4 May 2008:

In 1971, Ted Sarbin, my mentor at the University of California, Santa Cruz, handed me a copy of a paper he had just had published [Sarbin, T.R., & Adler, N. (1971). Self-reconstitution processes: A preliminary report. The Psychoanalytic Review, 57, 599-616.] This paper, with its wide-ranging analysis of the factors shared by diverse systems for bringing about drastic personal change, electrified me. The result was my undergraduate senior thesis on metaphors for death and birth and their implications for radical person change. In my thesis, I developed a method for using word etymology and metaphor analysis to analyze psychological constructs. Over the ensuing decades, I used this research method sporadically, to analyze concepts such as “psychological dysfunction”, “empathy,” and most recently “insight” [Elliott, R. (2006). Decoding Insight Talk: Discourse Analyses of Insight in Ordinary Language and in Psychotherapy. In L G. Castonguay & C.E. Hill (Eds), Insight in Psychotherapy (167-185). Washington, DC: APA.]

Several years ago I was asked to write a paper on epistemological issues in psychotherapy research for the Journal of Psychotherapy Integration. I have a long-standing interest in epistemology and philosophy of science, but am not by any means trained or deeply read in these fields, so I approached this assignment with fear and trembling. I ended up dealing with the situation by going back to basics: analyzing verbs of knowing using metaphor analysis, following Lakoff and Johnson, and returning to my old strategy of root metaphor analysis.

After a long delay, this paper has finally been published in JPI (the journal of the Society for Psychotherapy Integration) along with two accompanying papers, one an introduction and the other a commentary on my paper. I've never been given such treatment before and find it all a bit intimidating, but it is fun to see the final product and to view this particular piece of work through others' lenses, in this case three fairly heavy hitters in philosophical psychology: Robert Woolfolk, Frank Richardson, and Jack Anchin. Given that this paper is probably the most unusual paper I've ever published, it's a relief that they didn't just tear it to shreds.

In the title of the paper I refer to “linguistic phenomenology”, a term that refers to the use of language -- and particularly analysis of the metaphors used to construct words -- as a method for illuminating important human experiences. My use of this method was developed independently of Lakoff and Johnson’s later work on metaphor, most famously in Metaphors we live by (1980). However, my resumption of this method has been inspired by their work, especially their 1999 book [Lakoff, G., & Johnson, M. (1999). Philosophy in the flesh: The embodied mind and its challenge to western thought. New York: Basic Books.]

Reference: Elliott, R. (2008). A Linguistic Phenomenology of ways of knowing and its implications for psychotherapy research and psychotherapy integration. Journal of Psychotherapy Integration, 18, 40-65.

Abstract: In this article, I use the linguistic methods of Lakoff and Johnson (1999) to deconstruct the underlying conceptual structure and metaphors for three key verbs of Knowing, in order to answer three central methodological questions: First, is Description possible? Yes, in the sense of writing things down carefully but fallibly, while trying to avoid the danger of confusing permanence with truth. Second, is Interpretation inevitable? Yes, in the sense of Translating between an audience and a text, but not in the sense Making Something Easier to See or Constructing a Model (these are desirable but not inevitable). Third, are Explaining and Understanding fundamentally different ways of Knowing? Yes, they differ in structure (mediated vs. direct knowledge), direction (toward general simplicity vs. unique complexity), and effect (constructing a conceptual model vs. creating a relationship). Consistent with the goals of the psychotherapy integration movement, I conclude that Describing, Explaining, and Understanding are each essential to psychotherapy and psychotherapy research.

Ted Sarbin, whose 1971 paper set me on the path to this paper, died in August 2005, at the age of 94. It’s not common to dedicate scientific papers to people, and this paper carries no explicit inscription. Nevertheless, let it be known here that in fact this paper on the metaphors implicit in verbs of knowing is dedicated to his memory.