Sunday, September 20, 2009

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.

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