EFT Tribes Book Chapter Published

Entry for 27 December 2012:

The second edition of Pete Sanders’ popular book on the different forms of person-centred therapy (PCE) was released in the final weeks of 2012.  The first edition, published in 2003, has been a perennial favourite with the students in our post-graduate course in person-centred counselling, helping them to reflect on where they want to locate themselves as budding counsellors and what their options are.  In order to clarify the relationships among the different PCE therapy suborientations, Margaret Warner and others hit upon the metaphor of “many tribes, one nation”, pointing to unity amid diversity.  (From a Scottish point of view, “clans” works well also.)

Emotion-focused therapy (EFT) was mentioned in the first edition, sometimes critically, but was not represented by a chapter, leaving it status within the larger PCE nation unclear.  Then, about 18 months ago, Pete asked me if I’d be willing to do a chapter on EFT for the second edition of the “tribes book”.  Although academic pressures nowadays lead me to turn down most book chapter invitations, this one made sense to me, and I was pleased to take up the challenge.  As is common, work on the chapter got delayed and deadlines were extended but eventually several months ago I had to buckle down and produce something, which in quick succession got revised, copy-edited, typeset, proofed, and, finally, two weeks ago, published.

When I wrote this chapter I had in mind my students on postgraduate counselling diploma and MSc courses in the UK and elsewhere, as well as for folks with previous qualifications as counsellors or psychotherapists who might be thinking about coming along for training in EFT to build on their existing skills.  However, there is a lot of complexity to EFT and a lot of jargon. I hope that I’ve succeeded at least in part in providing an accessible overview of Emotion-Focused Therapy, thanks to help from the folks at PCCS Book and in particular Richard Miller, a former counselling diploma student who read an earlier version of the chapter.

Reference: Elliott, R. (2012).  Emotion-focused therapy. In P. Sanders (Ed.), The tribes of the person-centred nation: An introduction to the schools of therapy related to the person-centred approach (2^nd ed.).  Ross-on-Wye: PCCS Books.

Change Process Research on Relational Depth: The Added Paragraph

Entry for 18 January 2010:

Sometimes, an editor or reviewer will call for a last-minute revision that turns out to be a kind of gift, because it takes the paper to another level. In my forthcoming paper on Change Process Research, to appear in the next month or two in Psychotherapy Research, one of the reviewers challenged me to add an example of how the framework of types of change process research I’d been presenting might inspire research. When I asked myself what kind of therapy process might provide a good example, I suddenly thought of Relational Depth, which is a sort of University of Strathclyde speciality. The following paragraph came quickly after that, as I outlined a program of research on this therapy process variable:

Instead [of an RCT on Relational Depth], any one of the designs reviewed here provides a sounder basis for inferring the operation of particular therapy processes in bringing about client change. The optimal strategy, however, is to use several different Change Process Research designs, within or across studies, to build a convincing case for a particular change process. Take for example relational depth (Mearns & Cooper, 2005), a newly-minted formulation for a powerful state of felt connectedness between client and therapist. In order to make a strong case for the causal efficacy of this change process, researchers might want to start with Helpful Factors studies, in order to document the existence and general nature of moments of relational depth (e.g., Knox, 2008). Next, Significant Events studies, using Comprehensive Process Analysis or Task Analysis, could be used to develop and refine models of how client and therapist behaviors and experiences unfold and interact during episodes of relational depth. These models could be further tested at a micro-process level using the Sequential Analysis approach. Finally, quantitative measures (e.g., Wiggins, 2009) could be developed and used in Process-Outcome studies to predict therapy outcome. A body of such complementary studies would go a long way toward establishing the causal efficacy of relational depth in bringing about change in therapy, something that would be difficult if not impossible to do using randomized clinical trials.

References:

Knox, R. (2008) Clients’ experiences of relational depth in person-centred counselling. Counselling and Psychotherapy Research, 8:3, 182-188.

Mearns, D. & Cooper, M. (2005). Working at Relational Depth in Counselling and Psychotherapy. London: Sage.

Wiggins, S. (March, 2009). Developing the Relational Depth Inventory: Prevalence, Moderators & Characteristics of Relational Depth Events. Paper presented at Meeting of the UK Chapter of the Society for Psychotherapy Research, Ravenscar, UK.

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.

SPR-UK Ravenscar 2009 Meeting

Entry for 16/22 March, 2009:

Last weekend we went to the latest conference of the UK Chapter of SPR, the Society for Psychotherapy Research. SPR-UK has been struggling a bit to maintain itself over the past few years, and last year the annual conference had to be cancelled because of lack of interest. This year was difficult also, with many people hesitating or withdrawing because their employers were no longer willing pay their way; however, we did manage to put together a small meeting with about 20 participants, about the size of some of the Ohio SPR meetings (put together in the early 00's by Bill Stiles, Tim Anderson, me and our students). Nevertheless, the level of presentations and discussion was quite good, the scenery stunning, and the food excellent.

Having talked myself into doing 4 presentations, the pace of work was unrelenting. I started off with a presentation of Beth and my PCE meta-analysis, now well-honed. A bit more difficult was the workshop on research training that Sue Wheeler and I were set to do, but which I ended up doing on my own when Sue couldn’t make it in time due to a prior commitment. Fortunately, Sue sent a very helpful set of notes, which I followed. Particularly useful were the following questions, which the three participants explored:
-What has been your best research training experience? What made it the best?
-What has been your most unhelpful training experience?
These questions (which are really Change Interview questions applied to research training) produced some very useful comments, emphasizing the relational aspects of research training and the value of learning in collaborative research teams.

In fact, the experience left me thinking that it would be really interesting and useful to do a larger study on the topic of helpful and unhelpful factors in psychotherapy/counselling research training. If I could just find the time… maybe this could be a component of the next phase of the Researcher Development Initiative project that I'm involved with (see Blog entry: http://pe-eft.blogspot.com/2009/01/rdi-training-trainers-project.html).

After the first day of the two-day conference, I stayed up late trying to put together my presentations for day 2. I fell asleep halfway through the first of these, a paper outlining the experiential approach to research training; however, I was able to finish it the next morning in time for the presentation.

I managed to throw together enough bits and pieces to be able to give the final paper, a preliminary report on our Rasch analyses of the SCL90R, utilizing data from the Aberdeen group, but it was not one of my better presentations, and I was relieved when it was done.

The UK SPR group appears to be resolved to make another try at organizing a larger conference, and even to meet again at Ravenscar, isolated though it is. This was Thomas Schröder’s first local area chapter conference as president and I enjoyed his enthusiasm and positive energy. We don’t know exactly how things will unfold; the UK chapter has gotten pretty small, work demands have increased, making running a small scientific organization increasingly a leisure-time activity; also, money for conferences has become increasingly scarce. The openness, flexibility, colleagiality, and even the level of the presentations all indicate that there is a place for SPR in the UK counselling/psychotherapy research scene, even alongside the obvious success of the BACP annual research conference. The latter is much better funded and organized, but feels a bit too regimented, lacks flexibility in type of presentation, and ends up feeling not as open or inclusive. I keep thinking that the ideal would be something that incorporated the best qualities of both conferences. In the meantime, there appears to be new blood and new energy in the UK Chapter of SPR, and the BACP research conference is still evolving, so there is hope that we will end up with two premier events for promoting and encouraging the development of research on psychotherapy and counselling in the UK.

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.

BACP Research Committee Meeting, London

Entry for 8 March 2008:

Years after first sounding me out, I was finally asked last year if I would be willing to be on the British Association for Counselling and Psychotherapy’s Research Committee. Last Monday and Tuesday was my first experience on this committee, which meets once a year in London. On Monday evening, I was pleased to meet up with my friends and SPR colleagues, Bill Stiles and Louis Castonguay (Louis somewhat jet-lagged from having only that morning), as well as my Strathclyde colleague Mick Cooper, plus Sue Wheeler (whom I seem to see every other week these days), Michael King (of King et al., 2000, fame), and the usual BACP suspects: Nancy, Suky, Angela. Andrew Reeves, the new editor of BACP’s research journal, Counselling and Psychotherapy Research, was also there, as were two other new members: Pete Bower and Paul Gilbert.

1. Paul Gilbert. Dinner conversation with Paul Gilbert revealed him to be a charming and entertaining fellow. More importantly, it turns out that he and I have been moving in intersecting orbits for years without fully realizing it: I recently wrote a book chapter for him on qualitative research, but neither of us realized that we shared an interest in emotion theory and emotion-focused change processes. Thinking back I now realize that Paul had written a favourable review of an early book chapter I did with Les and one of Les’ students: Greenberg, Elliott & Foerster (1990). Now, we discovered that we are both doing research on social anxiety. Paul is trained in CBT and is a past president of the BABCP (British Association for Behaviour and Cognitive Psychotherapy), but now regards CBT as a kind of “con” because it has become so syncretistic over the past 20 years. Now he is very involved in what he calls Compassionate Mind Therapy, a Third Generation CBT related to Mindfulness therapy and Acceptance and Commitment Therapy (ACT; Hayes), but based firmly in Buddhism. He has his own version of neuroscience-based Emotion Theory and is doing research on critic and compassionate dialogue processes. He promised to send us articles on what he’s up to and we discussed the possibility of my coming down to Derby to exchange ideas at greater length. This was an excellent contact and felt like a further step on our path of developing dialogue with folks in the CBT world. The world is filled with all manner of interesting things!

2. BACP Research Foundation Priorities. BACP is in the process of setting up a research foundation, so much of our time was taken up with brain storming research priorities for funding possible projects. This process generated a long list of favorite topics by those in attendance:

-Practice to research conversions: feasibility studies in which practitioners who have developed promising therapeutic approaches carry out feasibility studies.
-Research infra-structure: Set-up structures whereby BACP members can contribute to large, web-based data sets.
-Data mining of existing data sets (e.g., the various CORE data sets).
-Large-scale of RCT of a key clinical problem, such as couples counselling for marriage breakdown.
-Intermittent therapy through the life cycle (Nick Cummings idea), tracking clients over multiple therapy episodes.
-Long-term therapeutic management of important recurrent problems, e.g., chronic depression.
-Measurement of client counselling preferences (to support a client choice agenda).
-Counselling for grief to address recent controversies over counselling for normal bereavement (probably an RCT).
-Counselling for the two problems most commonly reported by clients: fatigue and crises.
-Why don’t clients come back? (client drop out).
-Systematic reviews of qualitative research.
-Writing of accessible books on important emerging areas of practice (e.g., counselling in schools).

Afterwards, on a long walk with Louis and Bill, we concluded, as a self-appointed subcommittee of three, that BACP’s Research Foundation really should focus on practice-based research, thus providing a complement to the concentration on RCTs by government funding agencies and appealing more directly to their members.

3. If I ran the zoo, part 2: Actually, separate from whatever the Research Foundation gets up to, I think that the BACP should actively promote practice-based research and therapy outcome monitoring as a benefit of membership. This would make BACP into one giant Practitioner Research Network (PRN). They don’t want to endorse any single outcome measure, which makes sense, but instead they could offer a choice of instruments, including CORE-OM, Psychlops, Personal Questionnaire and possibly the new depression-anxiety measure being pushed by the NHS. Each of these would be administered, scored, and stored online, with weekly progress monitoring automatically provided following Mike Lambert’s signal alarm method. It seems to me that this should be provided free as a benefit of membership to BACP members. As such, it would make possible a huge step toward making counselling/ psychotherapy an evidence-based profession. With more than 30,000 members and research on counselling in voluntary and private practice settings only now beginning, the possibilities are enormous!