Friday, January 23, 2009

HPCE ERG – Part 7: Pushing to Finish & Tackling PE Therapy

Entry for 23 January 2009:

Time is beginning to run out for the Humanistic-Person-Centred-Experiential Therapy Competences Expert Reference Group (ERG), so when we met again today Tony Roth really put pressure on us to forge ahead. Tony did allow us to badger him and Steve Pilling for a bit about various political issues, such as whether anyone is likely to pay attention to our finished product, and whether it will have any impact on things like regulation and the NICE guidelines. The answers to these particular questions were not particularly clear, but what is clear is that what we’re doing is all part of the mix of things happening right now at lots of levels, even if though the effects may not be immediate or direct.

However, Tony really is anxious to see this thing done, to such an extent that he attempted, in behavioral fashion, to offer various incentives to keep us moving, such as offering a prize for coming up with the right wording for something (I won but then he reneged on the prize...) Most amusingly, he delayed our lunch some time, leaving the sandwiches there on the side table to spur us on to finish the Basic Competences section (or perhaps to stop obsessing on minor wording issues). Nevertheless, being strong of will and high in psychological reactance, we resisted the temptation to cut corners, and continued to fine-tooth comb this section, now virtually complete, in great detail. Finally, just about one o’clock, we finished the run-through, and fell upon our hard-won lunch.

As we ate, Tony and I worked away at a couple of loose ends from the morning. After reviewing these additional bits, we spent time discussing potential structural problems with the latter parts of the framework. As I’ve previously reported, the HPCE competence framework we’re working on has five sections: Common Competences (shared all major therapy approaches), Basic Competences (here Person-centred/Relational in nature), Specific Competences (shared by many but not all therapists within an approach), Specific Adaptations (specific approaches that have empirical support, perhaps for specific client populations), and Meta-competences (literally, competences about the use of competences, having to do with the thoughtful implementation, adaptation and balancing of competences). Andy Hill, who is doing the legwork of extracting competences, has been worried most of the PE therapy competences are being put under Specific Competences, leading to two problems: First, PE therapy material is danger of dominating this part of the framework, which feels somehow out of proportion. Second, there’s a danger of not enough material being left in the Specific Adaptations section, leaving it too thin.

Actually, neither of these problems particularly bothered me. It doesn’t surprise me that PE therapy material runs through the Specific Competences. For one thing, we had to leave them out the Basic Competences required of everyone in the approach, because many PE-specific competences are unacceptable to classical Person-Centred folks, so they had to go somewhere. More importantly, PE therapy is itself an integrative humanistic PCE therapy, having borrowed bits and pieces from Gestalt, Focusing-oriented and existential therapies, via the means of turning key elements of practice in these approaches into PE therapy tasks. The Specific Competences simply unpack some of this, giving a broader range of humanistic therapies something to hang their hats on in the framework. I see that as a strength, and I really like the idea that the PE therapy tasks live within the HPCE framework as Specific Competences, the groupings of which roughly correspond to the elements of the PE Emotion Scheme model.

However, in our discussions today, we took this further in a very nice way, by deciding to add one or more person-centred and/or relational Specific Competences. This strategy does away with the problem of PE therapy dominating this part of the framework, while simultaneously pointing to empathy/relational tasks that had so far been left out of the framework, because they had seemed to be implicit in the Basic Competences: Empathic Affirmative at Vulnerability, Relational Depth Encounter (for? I don’t know the marker for this one yet), Rigorous Nondirectivity (my term for what my colleague and friend Beth Freire does; again, I’m not sure what the marker for this is: a great topic for a research project!). Various subgroups of the ERG will tackle these Specific Competences between now and our next (and possibly final!) meeting in February.

As for the second concern, about there being little left to put down for PE therapy as specific adaptation, I’ve figured that this problem had already been dealt with, at least to Tony and Steve’s satisfaction, in the process of dealing with the CBT and Psychodynamic competences. In fact, this turned out to be the case: We are simply to replicate the relevant Basic and Specific Competences as appropriate for the PE therapy Specific Adaptation section.

As we broke up about 4:30 this afternoon, the rain had cleared and day was already fading in Central London, but our spirits were high and we were joking and talking energetically; the morale seemed distinctly positive, despite the political pressures. All of us could see the end in sight and were already feeling a sense of accomplishment. Catherine Clarke, our carer representative, is satisfied that we were able to include psychological contact in the Basic Competences (although I would add that in the future it would be good to be able to add Contact Work as Specific Competence and a Specific Adaptation both). Vanja Orlans seems reasonably content that we have managed to incorporate enough to provide a place for the HIPS section of UKCP. Andy seemed not only have gotten unstuck from the dilemma of how to deal with PE therapy, but was excited about the possibility of using the work to find a space between classical Person-Centred and Process-Experiential therapies. More than anything, a group of people who had often been at odds with each other over various issues (some quite long-standing), both within the HPCE world (Cooper, Tolan, Lietaer, Clarke, Elliott, Orlans) and outside it (Roth, Pilling) had come together. Over the months, this group (together with Nancy Rowland and Sally Aldridge form BACP) gradually earned each other’s (at first perhaps grudging) trust, and forged a working unit, in a kind of intra-/inter-modality team-building exercise. That in itself is an important accomplishment. Who knows where that will lead?

RDI Training the Trainers Project: Facilitating the Research Journey

Entry for 23 January 2009:

Faced with multiple threats and a complex political situation, counselling in the UK needs to pull itself up by its bootstraps in very short order and become increasingly research active. To do this, it must produce and publish meaningful, politically useful research in several genres on key topics such as outcome studies with particular client groups (to provide political support) and research on change processes (to improve our therapies). However, this requires more active counselling researchers with the appropriate skills, which in turn requires more and better research training, which in turn requires more people able to teach counselling research, which in turn….As I said, it’s a bootstrapping operation.

That’s where the Researcher Development Initiative (RDI) Training the Trainers project comes in. Supported by an ESRC grant that Sue Wheeler and Nancy Rowlands managed, by dogged persistence, to obtain, Sue, Nancy, John McLeod, Kaye Richards, Julia Meeks (our intrepid evaluator) and I (with support from a couple of other outside experts, like Steve Trevelyan, from Social Work) have been meeting over the past 18 months to develop and deliver a set of training events and resources. The last two of the one-day workshops are happening this month, in London and Manchester, and the evaluation data are beginning to roll in.

For this reason, I got up yesterday at 4am to catch the train to York, for a follow-up meeting on the project, to review our progress and to think about where to go with it next. We noted that the project got off to a slow start, and that we’d had to cancel a couple of the one-day workshops because of low numbers; however, the 5-day Summer School was a rousing success and we’ve already had more than 40 expressions of interest in our doing it again next summer, with the same cast and format, thus time supported entirely by BACP (who co-sponsored the current project).

Our main worry at this point is how to help John and I deliver the major remaining piece of the project by the end of March: a training manual consisting of a longish overview text and a set of exercises and resources for trainers to use with their students. After some discussion, we determined that the solution is going to be for Sue to come up to Scotland to stand over us until we produce the goods. Hmm… to borrow an expression from my kids, “Robert senses a trap….”

Then we were on to thinking about the future. What can we do to increase our capital of productive research leaders, especially given that most of us are within 10 years of retirement? The Training the Trainers work obviously needs to continue, but as originally conceived it was pitched mostly at improving the research education of diploma level counselling students and, to a lesser extent, masters students. However, it became very clear to us at the Summer School that there a huge need to support counselling trainers not only in teaching research methods to their students, but also in helping the trainers themselves to upgrade their research skills via their own MSc and PhD studies or first counselling research projects.

In other words, we also need something aimed at a higher level: producing PhD level researchers well-trained in a range of qualitative and quantitative methods and focused on topics of strategic importance for the counselling field. So what will do this? A mentoring and networking program for identifying and nuturing promising junior researchers? A program to support lecturer-level counselling faculty in pursuing PhD studies? Something like the Norwegian Double Competency program I lectured to 4 years ago near Bergen? (This is a nationwide program of advanced studies for postgraduate clinical psychologists, offering a combination of advanced professional and research training via networks and regular joint conferences.) A series of conferences to set and highlight national priorities for counselling research? Probably all of these…

Early in the day, a phrase came to me: The Research Journey. Somehow, we need in various ways to encourage and support people in joining and travelling on The Research Journey. The Research Journey starts with curiosity, inspiration, imagination, and more than a bit of chutzpah: Wondering about what we can learn by studying counselling carefully, being inspired, having the nerve and being able to imagine ourselves actually contributing knowledge. It continues, odyssey-like, through delays, doubts, and frustrations; broken dreams, disappointments, and surprises; left-turns, break-throughs and ah-hah moments. One thing leads to another, as The Research Journey continues: interests evolve and transmute, as we age, perhaps growing wiser in the process.

Over course of the day, The Research Journey came to seem figural to me: How do we help people undertake, survive and even thrive on this Journey? To Sue, Nancy, and Kaye, one answer seemed obvious: Through the telling of Research Journey Tales, that is, by asking various of us tell our stories. If you'll excuse the Terry Pratchett Latin: In narritas, veritas!

Friday, January 16, 2009

Mediated Empty Chair Work

Entry for 16 January 2009:

One thing that we encounter in Process-Experiential/Emotion-Focused Therapy is that some clients have real problems trying to do any kind of chair work. There are various reasons for this, including fear of the strong emotions that can be evoked by this sort of work, but the most common issue is that the client just feels silly about doing it. This can be problematic when the client is having trouble accessing their emotions and at the same time presents a strong marker for some kind of chair work, in other words at the precise moment when chair work could really be useful.

A strong working alliance, a clear marker, and a confident but empathic manner all go a long way toward encouraging reluctant clients to engage in chair work. Nevertheless, over the years I’ve become convinced that, until they’re tried it and found it useful, almost nobody likes the idea of chair work. (Except theatre people; but that’s another story…) Furthermore, some clients simply won't go for it. It just sounds too strange.

What to do in these circumstances? Well, with empty chair work in particular, there are various alternatives: First, the client can speak to the air as if they were talking to the significant other; in other words, the task can be done without the physical symbol of the chair. Second, the client can speak to the therapist as if they were the significant other. Third, Sandra Paivio uses a version of empty chairwork in which the client imagines the other to be present in the empty chair, but instead of speaking directly to the other, they speak to the therapist about the significant other. (Sandra reports that this way of working is generally effective, but somewhat less effective than direct empty chair work.)

But another thing that can be tried (that makes four) is for the therapist to engage in a conversation with the imagined other on behalf of the client. This can most obviously be done with therapist taking the role of the client in conversing with the other. In addition, however, it is also possible for the therapist to mediate between client and imagined other, that is, to act as a kind of interpreter, for example: “X says for me to tell you that she still misses you and wishes you could be with her now.”

This might sound rather distant and indirect, but it turns out that it can be quite an evocative experience for the therapist, requiring the deepest empathy with the client and easily touching the therapist’s own issues with important others. It seems to be an approach that is worth exploring further, especially for clients who find empty chair work embarrassing and threatening!

Emotion-Focused Psychotherapy 2009 Level One Training

Facilitated by Robert Elliott & Jeanne Watson
Monday 13th July – Thursday 16th July 2009; 9.00 – 16.30
Jordanhill Campus, University of Strathclyde, Glasgow

Emotion-Focused Therapy (EFT) – also known as Process-Experiential Therapy – is an active, evidence-based, integrative, approach to person-centred/experiential therapy, with particular relevance to working with depression, trauma, and anxiety difficulties. It has gained international recognition through the work of Les Greenberg, Robert Elliott, Jeanne Watson, Rhonda Goldman, Sandra Paivio and others. 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 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 previously psychotherapy or counselling training and the more EFT approach, the workshop will begin with an 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 past relationships 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, psychodynamic, cognitive-behavioural 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 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
Foundations, Emotion, Empathy, & Alliance Formation:
• Distinctive features of the EFT: neo-humanism & therapeutic principles
• Process-experiential emotion theory: emotion schemes
• Emotion response types & emotional change principles
Therapeutic Tasks, Accessing and Managing Emotion
• Therapeutic tasks and process formulation
• Emotion regulation
• Focusing and Clearing a Space
• Skills practice

Reprocessing Problematic Experiences
• Empathic exploration, evocative empathy, empathic conjecture
• Evocative unfolding, Narrative Retelling, and Meaning Creation
• Skills practice
Active Expression Processes - I
• Dialectical constructivist models of self
• Two chair dialogue and splits
• Accessing adaptive and problematic emotional responses
• Skills practice

Active Expression Processes – 2
• Accessing core problematic emotion schemes
• Varieties of splits
• Adapting two-chair work to different kinds of clients
• 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

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, and the Distinguished Research Career Award, Society for Psychotherapy Research. 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 EFT. She conducts workshops in 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 has been set at £445. Please note that to keep costs to a minimum, catering is not included in this fee.

We are pleased to offer an Early Bird Discount of £50.00 to those who book before 31st March 2009. To take advantage of this offer, applications must be received by this date with no exceptions.

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

Sunday, January 11, 2009

Summary of Nontherapy Explanations and How They are Assessed in HSCED

Entry for 11 January 2009:

In revising the adjudicated Hermeneutic Single Case Efficiacy Design (HSCED) paper (see blog entry just previous to this one), I had to cut a lot of nice material, including a longish section summarizing the eight nontherapy explanations or validity threats that HSCED systematically evaluates in order to counter the therapist/researcher’s desire to see the client change (the first four explanations) and for therapy to be responsible for those changes (the last four explanations). However, it seemed a waste to just discard this material, so I’m including it here, lightly revised from the discarded section, in the hope that it may provide a useful summary:

1. Trivial or Negative Change. The first four nontherapy explanations assume that apparent client change is illusory or artifactual. To begin with, the apparent changes may be negative or trivial. On the one hand, clients might describe a change in highly qualified or ambivalent terms ("I guess I’m doing a bit better, sort of."), or they may describe changes in other people or their life circumstances. In the same way, changes on quantitative outcome measures may also fall into the trivial range (e.g., one point on the BDI). Alternatively, changes, both reported by clients and evident on outcome measures, might be negative, casting doubt on the overall effectiveness of the therapy, or even suggesting that it has been harmful. To evaluate for trivial or negative change, researchers can calculate reliable change index (RCI) values (Jacobson & Truax, 1991) for our three key measures (SCL-90-R, IIP, and PQ values taken from Barkham, Hardy, & Startup, 1996; Ogles, Lambert & Sawyer, 1995). (In other words, our definition of trivial change was change that did not exceed measurement error.) In addition, in order to assess for negative changes, the interviewer can ask the client to describe any negative changes which might have occurred over the course of therapy, and also asked them to rate the importance of each change (cf. Kazdin (1999), using a 5-point scale. In addition, the manner of the client's description can be examined for qualifiers and other forms of ambivalence.

2. Statistical Artifacts. Related to the possibility of trivial change is statistical error, including measurement error, regression to the mean, and experimentwise error (measurement error has already been discussed under the heading of trivial change). Regression to the mean occurs when measurements with less than perfect reliability are selected on the basis of their extreme values. This introduces bias that is not present when the measurement is later repeated, resulting in the second measurement taking a less extreme value, thus producing illusory change. This can be assessed by repeating the Personal Questionnaire prior to the client beginning therapy. In addition, the researchers can assess the duration of the client's problems. Experimentwise error is a function of carrying out multiple significance tests on change measures. When examining many measures for evidence of change, some apparently reliable differences may occur due to chance alone. For example, when three measures are used to evaluate the reliability of pre-post change, with the relaxed significance level used in HSCED, each measure has .2 probability of indicating change when none existed (Type I error). The solution used here was to require reliable change on two out of four measures (this corresponds to a probability of .18).

3. Relational Artifacts. Apparent client improvement may also reflect interpersonal dynamics, in particular, client efforts to impress the therapist or research staff with clinical distress at the beginning of treatment, coupled with the opposite emphasis at the end of therapy, intended to express gratitude or justify ending therapy. In order to determine the role of self-presentational interpersonal artifacts, researchers can look at the client’s Change Interview data, paying attention to nuance and style, using Bohart and Boyd's (1997) plausibility criteria of elaboration and discrimination, assessing for the presence or absence of specific details about what has changed and how the change came about (elaboration). In addition, researchers can look for vague, global descriptions vs. differentiated descriptions containing both positive and negative elements.

4. Expectancy Artifacts. Cultural or personal expectations ("scripts") or wishful thinking may also give rise to apparent client change. That is, clients may convince themselves and others that since they have been through therapy they must therefore have changed. Post-therapy qualitative accounts are particularly vulnerable to this sort of bias, but quantitative ratings are also susceptible. As with relational artifacts, expectancy effects can be assessed by examining the language the client uses to describe his or her experience, in particular looking for expectation-driven descriptions that rely on shared cultural schemas about the effects of therapy and are therefore limited to standard or clich├ęd phrases, such as "someone to talk to," or "insight into my problems." By contrast, descriptions that are idiosyncratic in their content or word choice are more believable. In addition, expectation-driven expressions can be expected to sound vague, intellectualized or distant from the client's experience, as opposed to detailed, careful, and self-reflective (cf. Bohart & Boyd, 1997). In addition, the client can be asked to rate each of their changes for the degree to which they expected vs. were surprised by it.

5. Self-help and Other Self-Correction Processes. The remaining nontherapy explanations all assume that change occurred, but that factors other than therapy were responsible. First, client internally-generated maturational processes or self-help efforts may be generally responsible for the observed changes. For example, the client may have entered therapy in a temporary state of distress which has reverted to normal functioning via the self-limiting nature of temporary crises or the person’s own problem-solving processes. Alternatively, the change could be a continuation of an ongoing developmental trend or self-help efforts independent of therapy. A general strategy for evaluating the final four nontherapy explanations is to ask the client. Similarly, the client can also be asked to assess how likely he or she feels the change would have been without therapy. Therapist process notes provide an efficient source of information about client self-help efforts, and can be used to account for shifts in PQ scores. Researchers can also looked for narratives of the client’s self-help efforts begun before or separate from therapy.

6. Extra-therapy life events include changes in relationships such as deaths, divorces, initiation of new relationships, marriages, births, and other relational crises, as well as the renegotiation of existing relationships. In addition, clients may change jobs, get fired from jobs, get promoted or take on new work responsibilities, change recreational activities, and so on. They may also include changes in quality of life due to physical injuries or illnesses or medical treatments. Extra-therapy events can contribute both positively and negatively to therapy outcome. It is also important to consider the bidirectional influence of therapy and life events on one another. The most obvious method for evaluating the causal influence of extra-therapy events is to ask the client. Researchers can use the Change Interview, to ask the client what they thought brought about their changes. (In this interview, the researcher asks about extra-therapy factors if the client fails to mention them and before asking about the influence of therapy, and also asks the client to estimate the likelihood that the change would have occurred without therapy.) In addition, researchers can look at therapist process notes to find out about extra-therapy events.

7. Psychobiological Causes. The next possibility is that credible improvement is present, but is due primarily to direct, unidirectional psychophysiological processes, especially psychotropic medications or herbal remedies and seasonal and endogenously-driven mood cycles. The most obvious approach to evaluating psychobiological factors is to keep track of medications, including changes and dose adjustments. Therefore, questions about medication and herbal remedies are included in the Change Interview. (Therapist process notes could also be used for this.)

8. Reactive Effects of Research. The final nontherapy explanation is the reactive effects of taking part in research. These include reactive research activities (e.g., PTSD assessment) that enhance (or interfere with) therapy, relation with the research staff, and enhanced sense of altruism. On the other hand, research activities can have negative effects on clients, especially if they are particularly difficult or time-consuming. Teasing out the reactive effects of research on client outcome can be difficult, but qualitative interviewing can help here as well. Thus, researchers can asked the client to talk about the effects the research had on them. A quantitative measure of the effects of research procedures can also be used.

Friday, January 09, 2009

Minor Miracles: Summing up the Holidays

Entry for 6/9 January 2009:

These few days after our return to Toledo from California, sandwiched in between the holidays and return to Scotland and work allowed us a gentle taste of Midwestern winter. Most of the days were clear and cold but not too frigid. It’s a peaceful time of year, the holidays done, a bit a space to breathe in, and by some miracle I was able to catch up on my unread email, reducing the pile from over 800 when we left Scotland to about 60.

The larger miracle is that this has allowed me to finally get some writing done on the adjudicated HSCED (Hermeneutic Single Case Efficacy Design) manuscript, whose revision I’ve been sitting on for more than five years. The original version was ridiculously long; I’d had the delusion of being able to publish it as a series of 3 related papers, but the editor (my friend Bill Stiles) wasn’t having it and had asked me to condense it into one paper of no more than 60 pages. Speaking as a former journal editor, I think this was a good call, but presented me with a lot of work at a time when my job had become very stressful and I was doing a lot of extra work, such as teaching 8 weeks a year in Belgium. Then we moved to Scotland, and thing got more complicated. Now, however, my students in Scotland are starting to produce their own HSCED studies and John McLeod and I are in the middle of a run of conferences on systematic case study design, so the pressure is on to get this key paper done.

I’d been progressing it slowly, using my 15 min/day regime, but this was taking a long time. Finally, this past Monday, I emerged into the clearing left by having gotten my email under control for the first time in a year. I started working on the aHSCED paper for 3 – 4 hrs/day. A paper like this is filled with complex details that are tricky to handle and describe, and I was faced with 10 pages of editorial feedback to deal with, always a daunting prospect. There is a real art to writing a scientific paper with maximum clarity, balancing one’s interests, the reviewer’s suggestions, and what the data are saying. To do it well is really a labor of love, and I believe that it shows in the final product. It needed big blocks of time to finish these revisions, but I made steady progress, and finally, yesterday (Thursday) I sent it off to my seven co-authors for their suggestions and approval. Whew! We all went out to Kotobuki, our favorite Toledo-area Japanese restaurant, to celebrate belated November and December birthdays. Mission accomplished! There will probably be two more revisions after this, but they are unlikely to be as extensive or as time-consuming.

Now we’re taking Kenneth back to school in Cleveland, facing a major winter storm that is advancing through the area and which may interfere with our flight back to Scotland tomorrow afternoon. Our peaceful winterlude is ending, but it’s been a time of clearing things out (not just email; most of us has a short, sharp stomach bug over Christmas). Also for getting caught up on sleep, for kicking back a bit, for reading graphic novels (volume 5 of Fables and volume 3 of the League of Extraordinary Gentlemen) and science fiction (Stross’ Saturn’s Children), for getting back into running (3-4 times a week, including a 7.5 mile run around the Pleasanton ring road on New Years Day with Kenneth), and for finally healing from the exhaustion and lingering effects of last Fall.

Kenneth’s pleased to see his friends, and as we sit around Aladdin’s in Cleveland Heights, eating our smoothies and wraps, they all chatter about what they did over winter break and about Pokemon, which they all seem to have been playing lately, out of some kind of nostalgia. We leave them to do their grocery shopping, and head back into the early January just-before-the-snow-storm-Friday-night-rush-hour-traffic. We hide it, but we’re a bit teary when we think about how many months it’ll be before we see him again, but such is our life, and his. We are on our way home now, back to Toledo through the ice and snow, and thence back to Scotland and our life there, thankful for miracles, great and small.

Friday, January 02, 2009

Five Ways to Analyze HAT Data

Entry for 2 January 2009 (from Toledo, Ohio):

Steff Revell, one of our MSc students has been using the Helpful Aspects of Therapy (HAT) form to study Adventure Therapy. She contacted me yesterday to ask, “how you analyze the helpful/hindering events part of your HAT questionnaire.” She’s given permission for me to post my reply here:

The Helpful Aspects of Therapy (HAT) Form generates lovely qualitative descriptions of significant therapy events. These data tend to be informative, lively and information-dense. There are lots of different ways to analyze HAT data:

First, if it's a new therapy or population that hasn't been studied in this way before, it may make sense take an open-ended approach and do an open coding (one aspect of Grounded Theory) of the descriptions, just to see what emerges.

Second, it's useful to know that HAT forms generate a fairly specific range of types of information:
(1) Descriptions of helpful things that happened in the therapy (=Processes)
(2) Descriptions of helpful reactions the informant had to the therapy (=Effects)
(3) Descriptions of previous states of affairs or events that explain why the informant found something helpful (=Context)
(4) Descriptions of hindering processes, effects or contexts (this is much this common, so processes, effects & contexts can be grouped)
In Grounded Theory terms (following the Elliott-Hill interpretation), these 4 kinds of information are called "domains", and can be useful for organizing your analyses into smaller collections of meaning units that are easier to analyze.

Third, a couple of different content analysis systems have been developed for HAT data, one for generally analyzing the kinds of therapeutic effects generated (The Therapeutic Impacts Content Analysis System, Elliott et al., 1985); the other specific to individual experiential therapy (Elliott et al., 1988). If the relevant variables in the therapy you are studying match the variables measured in these content analysis measures, you could train yourself and a couple of other folks to use them to rate your HAT data.

Fourth, because HAT are often pretty information-dense a more intensive, interpretive discourse approach to qualitative analysis can used, particularly if you're bringing a particular theoretical interest to your study, such as relational or emotion processes. I've done a small demonstration project illustrating this approach (Elliott & Schnellbacher, 2007), if it sounds useful.

Fifth, a related discourse analytic approach is to identify partiicular kinds of events of interest and study how informants construct descriptions of them. I did this for insight event descriptions in Elliott (2007).

References: [unpublished documents available from me by request]
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.
Elliott, R., Kemeny, V., Clark, C., Morehouse, V., Norgard, T., San Gregory, A. & Van Tassel, J. (1988). Helpful Aspects of Experiential Therapy Content Analysis System (Version 2.0). Rating manual, Department of Psychology, University of Toledo.
Elliott, R., Reimschuessel, C., Sack, N., Cislo, D., & James, E. (1984). Therapeutic impacts content analysis system - 1984 version. Rating Manual, Department of Psychology, University of Toledo.
Elliott, R., & Schnellbacher, J. (June, 2007). Relational and Emotion Processes in First Sessions of Process-Experiential Therapy: An Interpretive Discourse Analysis of Clients’ Accounts of Significant Events. Paper presented at meeting of Society for Psychotherapy Research, Madison, WI.