Saturday, September 26, 2009

Dundonald Castle Adventure

Entry for 26 September 2009:

This week's Saturday Adventure: A visit to Dundonald Castle, in Ayrshire, an hour's drive south of Glasgow. It’s a ruined castle built by King Robert II of Scotland in the 14th century; Historic Scotland has fixed it up, as they do, shoring up the crumbling walls and putting in decent floors and stairs. Tracy, a young woman, wearing a warm plaid wool duffle coat against the chill inside, gave us a tour of the place, including the Laigh, or lower hall, the dungeon pit or oubliette, and the now-roofless great hall. It was a lovely day and the castle is placed at the top a hill with lovely views; we could see the island of Arran away to the west. The Laigh Hall has a wonderful stone vaulted ceiling. Every August the town of Dundonald puts on the Dundonald Games. Tracy shyly told us that she had been this years’s Queen of the Games.

After a snack in the visitor centre, we explored Dundonald Wood, west of the castle, where found the two ruined houses, Auchans and Old Auchans, left by the Cochrane family, who owned the castle until donating it to Historic Scotland. The castle, centuries older, is in better shape than these houses.

Returning to Glasgow, we parked the car in Hyndland and topped off our Adventure by taking the train to the City Centre and going out to Wagamama for dinner.

Friday, September 25, 2009

The Monkey’s Behind

Generally, before I go out for a run in the morning, I listen to National Public Radio from the United States, picking up the latest 5-min news summary, followed by the previous day’s All Things Considered, its evening news program. (Many Americans feel about NPR the way the many Brits feel about Radio 4.) This little bit of American culture helps keep me grounded in my sense of who I am, even though I was far away from home.

The other morning I caught an interview with one of this year’s MacArthur Foundation grants. This is a highly prestigious grant program, known popularly as “genius grants”, an interesting feature of which is that you cannot apply for it. This means that every year, the MacArthur Foundation drops 25 grants (a half-million dollars/year for 5 years) on unsuspecting people in various pursuits, ranging from the arts to quite esoteric areas of science.

The interviewee was a charming American poet named Heather McHugh, who is looking forward to having time off from teaching in order to concentrate on her own writing experiments. The interview closed as such interviews must always do, with the interviewer (Robert Siegel) asking her how she feels the award will change her life:

McHugh: … and also as General Stillwell said, ‘The higher a monkey climbs, the more you see of his behind’.

Robert Siegel: (laughs) You’re concerned about possible exposure from this.

McHugh: Exactly! That’s the noun exactly!

This humorous quotation has been popularized in recent years by former US Secretary of Defense Donald Rumsfeld, but I don’t think we should hold that against it. General Joseph Stillwell was a rather eccentric American army general who commanded US forces in Burma during World War Two. This is from Time magazine, 6 April 1942:

In Mandalay last week a correspondent recalled a characteristic crack made by Lieut. General Joseph ("Uncle Joe") Stilwell, who now commands U.S. and Chinese forces in Burma. Said Uncle Joe: "The higher a monkey climbs on a pole, the more you can see of his backside."

I hadn’t heard this before, but it really struck me as both very profound and amusing at the same time. In our attempts to become the most important or famous etc monkey, a lot of us spend a lot of time trying to climb the pole. What this saying says to me, however, is that this is illusion, that what generally happens is that other people end of witnessing more and more of our most unlovely aspects: our arrogance, our narcissism, our self-defeating behavior, our contradictoriness, even our cruelty. The only proper course of action, therefore is not to be take ourselves so seriously, to be humble, interested and giving to others. If there are several monkeys up in the tree with us, then at least we will have company!

Wednesday, September 23, 2009


Entry for 13 September 2009:

The town I grew up in, Lodi, California, is just east of the San Joaquin River Delta, an area of rich, dark farmland used extensively for farming asparagus and interwoven with a network of waterways. Many of these are referred to locally as “sloughs” (rhymes with “you’s”, which is Glaswegian Scots for the second person plural pronoun).

However, there are other “sloughs”: There is also what a snake does with its old skin, but the getting-rid-of-something-no-longer-wanted verb “slough” is pronounced with a final “f” so it rhymes with “stuff”. However, on my way back from the BAPCA conference, a few minutes east of Reading on the historic Great Western train line, I was surprised to find our train stopping at the town of “Slough”, pronounced so that it rhymes with “now”. In British English, a slough (rhyming with “now”) is a muddy or marshy area, but in American English a slough (rhyming with “you”) is a secondary fresh water channel in a river delta (French: “bayou”). Both are wetlands, which we now know to be very important ecologically for harboring different animal species, for filtering out contaminants from the water supply, and for protecting coast areas from hurricane and other severe storms.

Although unkind jokes on the name of the town of Slough (rhyming with “now”) apparently go back to Shakespeare, its citizens should be proud of their association with such a vital and charming geographical feature, and not be tempted to slough off this ancient name in favor of some soulless, more modern corporate alternative.

Sunday, September 20, 2009

Sunday Adventure in Glasgow

This was Glasgow Open Doors weekend. Because I was teaching yesterday, we had a Sunday Adventure today, visiting the Britannia Panopticon Music Hall, a decaying, once-splendid theatre, where Stan Laurel, of Laurel and Hardy, had his debut. After that, we went to the Police Museum, which is run by retired policemen, who love to talk your ear off. Both places are run by volunteers who have found a little piece of reality to love and cherish. I suspect that there is a deep truth in this someplace.

Twenty-Five Fun Research Projects to Do in a Therapy Research Clinic

I generated this list of 25 research projects as a way of telling our MSc Counselling and DPsych Counselling Psychology students about the wonderful data archive that we have developed in the Research Clinic over the past 2 years. However, it illustrates more broadly the kinds of research that is possible with research clinics such as ours, and also the wide range of different kinds of psychotherapy research that is being done today. I'm posting it here because I think it's of more general interest beyond our students at Strathclyde.

The List of Projects:

The following is a list of research topics and studies that are possible with the archive of data in the research clinic. It makes use of most of the data being collected but is not exhaustive. Topics marked by an asterisk are high priority topics, needed for current and planned core aspects of the research program. Each topic is first defined, then some of the main variations are described, laying out multiple different studies that can be carried out to address the topic. The full version of this list is in a table format, with additional descriptive information about each topic. I estimate that there are at least a 100 studies described here, providing a detailed agenda for making use of the Research Clinic data archive. Topics are organized by their main emphasis.

(*Indicates high priority for the research team.)

A. Outcome

1. Quantitative Outcome in Practice-based research protocol.

Separate studies on:

(a) Pre-post differences (significance, effect size, reliable change) on: CORE, SI, PQ

(b) Associations among outcome measures

(c) Dose-effect relationships on PQ: plot amount of client change or % reliable change by number of sessions; at termination & along the way

(d) Signal-alarm analyses: What is the rate of red & yellow signals? Does red predict worse outcome? (also: SA protocol)

*2. Interpretive case studies of PCE therapy outcome & change processes: Hermeneutic Single Case Efficacy Design (HSCED). Masters level: one case; doctoral level: 3 cases.

Case selection possibilities: (a) particular client presenting problems (e.g., generalized anxiety, PTSD); (b) different kinds of Social Anxiety (e.g., specific vs. generalized/avoidant; (c) poor outcome cases; (d) nondirective PCT; (e) with different kinds of accompanying problems (e.g., SA with obsessive-compulsive processes, borderline/fragile process)

3. Post-therapy client qualitative change (cf. Klein & Elliott, 2006)

(1) Time period:

(a) At mid-therapy.

(b) At end of therapy.

(c) In the post-therapy period (at follow-up).

(2) Analysis method:

(a) Qualitative analysis of changes described by clients.

(b) Content analysis of changes described by clients.

(3) In addition, can compare clients with:

(a) good vs. poor outcomes.

(b) different presenting problems (e.g., SA, depression, PTSD).

(c) Student vs. tutor therapists.

4. Sensitivity to change: On which items do clients in PCE therapy show the most/earliest change?

Item analyses on CORE-OM, PQ at pre, post-10 and end of therapy

5. Healthcare utilization effects of PCE therapy. Work with health economists.

(a) Use instrument to calculate illness burden in clients at pre- and post-therapy.

(b) Use changes across therapy to calculate increases or decreases in healthcare costs

B. Process

*6. Observer Process Measures of Adherence/competence of PCT/EFT: (a) Interrater reliability; (b) consistency/differences across sampled sessions (early – mid – late); (c) convergent validity: agreement with therapist adherence self-ratings; (d) construct validity: agreement with client ratings on TRS

(e) Does adherence/competence predict outcome? (f) Do raters & therapists agree on session ratings?

Separate studies on:

(a) Therapeutic Relationship Scale - Observer (revised short form).

(b) Working Alliance Inventory –12 - Observer (Anderson)

(c) Therapist response modes (PCT, EFT)

(d) Content directive responses

(e) EFT tasks (client markers, degree & quality of therapist task effort)

7. Sequential process analysis of the relation between client level of self-explication and therapist processing proposals. Replication of Sachse, with separate samples of PCT and EFT.

Ratings of C explication and T processing proposals in sampled sequences from early, middle & late sessions.

(1) Assess inter-rater reliability; compare C => T and T => C influence.

(2) Different therapies: (a) PCT. (b) EFT

(3) Compare: (a) PCT vs. EFT; (b) point in therapy; (c) SA vs. Depressed clients; (d) Best vs Worse outcome clients

8. Client modes of engagement in PCT & EFT. Micro-processes engaged in by clients in sessions (e.g., externalized, experiential search, self-reflection. Comparison between PCT & EFT.

(1) Descriptive and psychometric analyses of therapist post-session ratings.

(2) Change over therapy

(3) Prediction of:

(a) Immediate session effects (general & specific).

(b) Relationship quality.

(c) Outcome.

9. Negative reactions to first sessions

Discourse analysis of first sessions after which client declined to continue with therapy; look for and categorize “signs of trouble”

10. Emotion Scheme Elaboration of Narrative process coding system (NPCS). (1) Locate emotion episodes in sessions (e.g., social anxiety). (2) Instead of Angus’ 3-category NPCS codes, add two more to provide complete coverage of all 5 aspects of the emotion scheme model: External (=situational-perceptual); Bodily-expression (=Internal); Experienced emotion (=Internal); Reflexive (=symbolic-conceptual); Action tendency (=no exact equivalent in NPCS).

(1) Use Emotion Narrative Scheme codes to code PCE sessions:

(a) Inter-rater reliability and consistency across sessions; frequency of emotion narrative codes.

(b) Change in Emotion Narrative Scheme codes across therapy

(2) Use scheme qualitatively to describe a client’s emotion schemes across therapy, sampling 1-2 sessions each from early, middle and late in therapy.

(a) Case studies tracking emotion schemes for particular clients.

(b) Study SA Emotion Narrative schemes across SA clients early in therapy to develop general schematic description of SA.

(3) Apply to different types of clients in PCT & EFT

C. Process-Outcome

*11. Observer Ratings of PCT facilitative conditions and outcome: facilitative conditions (empathy, warmth, unconditionality, genuineness; update Truax-Carkhuff tape rating measures) [=competence]

(1) Psychometric study: interrater reliability & consistency over time.

(2) Process-outcome/predictive validity study:

(a) session –level effects (PQ; Session Effectiveness Scale –C/T).

(b) Post therapy outcome.

*12. Therapeutic Alliance predictors of outcome (predictive validity of measures)

Different combinations of:

(1) Relationship measures:

(a) Client ratings.

(b) Therapist ratings.

(c) Observer ratings.

(2) Outcome measures:

(a) Session –level (PQ; Session Effectiveness Scale –C/T).

(b) Post therapy.

D. Pre-therapy Client Factors (predictors or process or outcome)

13. Taxonomy of client presenting problems and their relation to outcome

(1) Different approaches to defining types of clients:

(a) Use PQ items to identify different kinds of presenting problems.

(b) Use CORE-OM & SI items for cluster analysis across clients.

(2) Different criterion variables:

(a) Post-therapy outcome.

(b) Immediate session effects.

14. Interpersonal style and clients’ experiences of therapy. Use pre-therapy Inventory of Interpersonal Problems (IIP) to identify clients with different interpersonal styles (controlling, distant, unassertive).

Compare SA clients with different interpersonal styles on:

(a) Pre-post change.

(b) Quality of therapeutic relationship/alliance.

Use qualitative analysis to study experiences of clients with particular interpersonal styles on:

(c) Helpful factors.

(d) Significant event descriptions

E. Client Experiences

*15. Client retrospective perceptions of helpful aspects of therapy

Separate studies:

(a) Mid-therapy.

(b) End of therapy.

(c) During follow-up period.

Grounded Theory analysis

16. Client perceptions of hindering processes

Because of low baserates, use both retrospective interview and post-session data

17. Extra-therapy factors that affect therapy (after T. Mackrill)

Separate studies on:

(a) Resources (personal, situational).

(b) Obstacles (personal, situational).

18. How do clients experience of nondirective (ND) PCT therapy? Select clients with in highly nondirective therapies (use reputation or TRS ratings); rate sessions for nondirectiveness to confirm.

(a) Analyze client discourse about nondirectiveness (CI, session recordings).

(b) Analyze HAT descriptions (event type or ND-relevant discourse).

(c) Helpful factors (CI).

(d) Compare ND PCT vs. general PCT vs. EFT on client, therapist relationship ratings.

19. Relational processes in client descriptions of significant events in PCT (cf. Schnellbacher)

Interpretive discourse analysis of image of self-other in significant event descriptions

20. Emotion processes in client descriptions of significant events in EFT (cf. Elliott, 2007)

Interpretive discourse analysis of emotion talk in significant event descriptions

F. Significant Events

21. Types of significantly helpful events

Possibilities for sample/design: (a) in EFT; (b) in PCT; (c) EFT vs. PCT; (d) in clients with specific presenting problem (e.g., depression, SA)

Analysis possibilities: (a) Open coding; (b) content analysis

22. Relational depth events: Use Relational Depth Inventory (RDI; Wiggins) to identify sessions with RD events

(a) Use RDI description & session recordings to describe general characteristics of these events (where in therapy, session, who did what).

(b) Comprehensive Process Analysis of one (masters level) or three (doctoral level) events

G. Measure Development

23. Validation and revision of Strathclyde Inventory with a clinical population (Beth Freire)

(a) Scale structure: reliability, factor structure.

(b) Rasch item measure structure

(c) Convergent validity with CORE-OM, other outcome measures

24. Self-Relationship Scale: EFT outcome measure: self-attack, self-neglect, self-management, self-affirmation

Combinations of the following:

(a) Traditional psychometric study of scale structure: internal reliability; factor structure.

(b) Rasch item response structure analysis.

(c) Construct validation with other outcome measures (CORE-OM, Strathclyde Inventory, Inventory of Interpersonal Problems; Personal Questionnaire.

(d) Sensitivity to change across therapy.

(e) Comparison of PCT, EFT outcomes

25. Development of an observer measure of client modes of engagement.

(1) Descriptive and psychometric analyses: Interrater reliability & consistency over sampled sessions (early, middle, late).

(2) Convergent validity with T ratings.

(3) Change over therapy

(4) Prediction of:

(a) Immediate session effects (general & specific).

(b) Relationship quality.

(c) Outcome.

Monday, September 14, 2009

BAPCA Conference in Reading

Entry for 13 September 2009:

In 2007, not long after I arrived in Glasgow, the British Association for the Person-Centred Approach, or BAPCA, generously gave Beth Freire and I a grant to enable us to update my long-running meta-analysis of Person-Centred-Experiential therapy outcome research. This money paid for part of Beth’s salary for over a year, as we waded our way through an astounding 82 new studies and reviewed the previous analyses. BAPCA’s conference is held only every 2 years, so when the 2009 conference rolled around, they invited Beth and I down to Reading to present the fruits our labour and their investment. (A summary of our analyses was published last Autumn in the BAPCA journal, Person-Centred Quarterly.)

I spent this past Thursday and Friday teaching on our MSc course, so I missed the first two days of the conference. I took the Caledonian Sleeper down to London on Friday night, then caught an early morning train to Reading, arriving at the University of Reading Saturday morning in time for breakfast.

I found BAPCA in the midst of an organizational crisis: Its old steering committee had been in so much strife that no one would agree to serve on it, forcing an ad hoc interim group to limp along until this meeting. Without a steering committee to serve as a board of trustees, it could not function as a charity and would collapse, with various further negative consequences. Saturday afternoon would therefore be devoted to an EGM. What’s an EGM?, I asked. “An extraordinary general meeting”, I was told. Although I’m not yet a BAPCA member, I was asked to attend as an observer. (For reasons somewhat obscure to me, I have yet to join any professional organizations in the UK. I think it’s because I already belong to and maintain membership in 5 or 6 such organizations in the US and can’t get my head around joining another batch here.)

And so through the afternoon I watched as the organization tried to save itself. Actually, I suspect that many organizations could benefit from such a crisis. Death, as it is said, concentrates the mind wonderfully. (The Society for Psychotherapy Research looked into the Abyss at this 1999 Santa Barbara meeting, when it faced a potentially disastrous financial situation because of carelessly overbooked rooms. Those of us who there are deeply grateful for Larry Beutler for bailing us out.)

The relational conflict that had precipitated the crisis keep breaking out in the large group, threatening to derail the process of finding a way to a solution, and had to be contained again and again. Fortunately, it became clear early on that was a substantial number of people ready to step in, if such conflicts could be avoided and if the workload could be maintained at a reasonable level. A key piece of this centered around the definition and mission of BAPCA, that is, what its coordinating group members were being asked to represent. And this came down whether BAPCA is going to be defined in terms of a “classical” nondirective interpretation of the Rogers’ six facilitative conditions or whether a broader, more inclusive definition of person-centredness is going to be applied, thus letting in people like me. They’d done a survey of their members, which turned out to be helplful, because from the survey data, it does appear that about a quarter of BAPCA’s membership favours a narrow nondirective definition, while around a half favours a “large tent” of folks, as long as they subscribe to the Six Conditions. (To borrow from William West’s keynote address earlier in the day, Rogers’ Six Conditions function analogously to the Nicene Creed.)

However, it’s also clear that BAPCA members are not ready to follow the example of the World Association for Person-Centered and Experiential Psychotherapy and Counselling (WAPCEPC) and explicitly add “experiential” to its name, partly out of respect for the vocal quarter who oppose this and partly because of the ugliness of the resulting acronym. (Who can blame them?) Nevertheless, the definition of exactly what is meant by “Person-centred” remains the subject of disagreement and sometimes controversy, and it was proposed that there should be a day-meeting devoted specifically to this issue.

After a break to clear our heads and stoke up on caffeine. After that, the people who heard been listening to me muttering at the back of the room urged me to say something, so I stood up and said my piece:

“I’m an outsider here, but my dream for BAPCA is that Beth [Freire] here [gesturing to her], and I would both be equally welcome in BAPCA and be seen as equally person-centred. Beth and I are colleagues and we have often listened to recordings of each other’s therapeutic work. We admire each other’s work as a therapist, even though what we do is clearly different. So I suggest that when you meet to discuss the meaning of person-centredness you spend time playing recordings, looking at what people are actually doing in therapy, because then the discussion will be grounded in concrete practice, rather than getting stuck going around in circles at the level of ideology.”

Then I sat down, feeling rather nervous, fearing that I had overstepped my role as observer.

I won’t say this little speech of mine turned things around, which would have made a nice narrative. However, it did seem to be part of a larger process of reflection and redirection in which there followed, in succession, a show of hands strongly affirming a “broad church” interpretation of Person-centredness; a proposal (from Beth) that a large body of volunteers be created to support the board; some guidance on what was expected of the board; a collection of nominees who agreed to stand for election to the board; and as people filed out of the room just before the janitors closed the building, a vote for the board.

There then followed the conference dinner, with both long talks and dancing. Tiane persuaded the DJ to put on a set of Brazilian music, and Beth, Tiane and one of their friends got out there and really danced, along with Suzanne, Janet, and many others. Afterwards, I was so tired I could barely stagger back to my room.

Beth stayed up very late revising our presentation and the next morning we went over it, revising it until we looked up and saw 10 people waiting for us to stop fiddling with the slides and tell them about them instead. It was a very enjoyable session, with Beth and I sharing the presentation and lots of lively discussion with the audience.

For the last plenary Maureen O’Hara did an inspiring presentation on the global crisis, suggesting that we had really better stop fighting with each other and devote ourselves to the multiple crises facing everyone. As soon as she was finished, Sue Wiggin and I hurried downstairs to catch the bus back to the train station and home. Along the way, we managed to get ourselves on an earlier train back up north and spent the time to Preston reviewing the outline for her PhD dissertation and the plan for the remaining studies that will make it up. I finished copy-editing the manuscript we’re trying to tie up, but in the process she ended up running more analyses and adding more bits to it. She left the train at Preston, while I continued up the West Coast Line. As I walked up the hill from the station, the last sun was lighting up the red brick chimneys of Hyndland, making them glow. It had been a short but intense weekend and I was good to be home again.

Sunday, September 13, 2009

Mid-September Update

Entry for 11 September 2009:

We’ve been back in Scotland for two weeks and a bit, a busy time catching up from our holiday, picking up loose pieces, of work, email, clients, admin, medical appointments, friends, manuscripts, and so on. In this early September time, things have seemed to hover, a busy calm before the intensity of courses beginning and the usual run of business as usual. Changes are afoot in the University, for the coming year, on top of the changes already set in motion, and with it some sense of unsettledness and uncertainty. For now, I’ve been enjoying the feeling of relative calm amid the busyness.

Part of this is that I’ve cut back on some of my teaching: much less evening teaching and somewhat less teaching on the Diploma course. Some of this (EFT-2) has been shifted to Saturdays, which will mean that some Saturday Adventures will need to become Sunday Adventures. Perhaps after three years I’m finally learning how to get a better balance in my job? We shall see…