The Winter Labyrinth

Entry for 28 December 2006 (California):

The last of the rain passed through yesterday afternoon, followed by a front of clear, cold air. At 3am we woke up and looked out the windows to see the stars sparkling brightly between the tree branches. Through the south window I could see Orion’s belt blazing just above the mountain ridge.

In the morning, there was frost all around, melting quickly where the bright morning sun shines, but lingering still in the shadows. The air was cool, crisp, and clear.

No visit to Murray Creek is complete without walking the Labyrinth. However, the last couple of times my mom has approached the labyrinth, she reported a sense that its energy has been blocked in some way. For this reason, we thought it would be a good idea to let her guide us into it today. Furthermore, the small foot bridge across the creek usually suffers some damage in the winter, and this year the guide rope has been washed away, leaving two somewhat wobbly boards. My mom and sister Anna decided to drive around the back way, through the neighbors’ property, while the rest of us dared the bridge, which was still a bit icy at one end.

The Murray Creek labyrinth sits in a meadow on the south side of the creek, at the foot of a steeply-rising ridge, its central axes oriented to the cardinal directions. At this time of year, right after the Winter Solstice, the ridge casts its shadow over the southern half of the labyrinth, even at midday, leaving it in perpetual shade. The fallen oak leaves around and within this half of the labyrinth were rimed with delicate frost patterns. My mom and Anna drive up and get out of the car. My mom stands at opening to the Labyrinth, looking east, and tells us it is OK to go ahead; she and I follow after the others.

Although it is always centering and peaceful, the Labyrinth changes with the seasons and the time of day: The Summer Labyrinth smells of dry grass in the hot sun of summer days; the ground is hard, and at night there are crickets and wheeling bats. The rocks of the Winter Labyrinth stand out more vividly and the ground is damp and soft and green. Most strikingly today, the Winter Labyrinth has a seasonal duality: Its north half is brightly lit by the sun, with dew sparkling in the grass, as if anticipating spring and summer; while its south half is in perpetual shadow, still frost-covered and locked in winter. It’s as if this incarnation of the Labyrinth contains within it the turning seasons, light and dark, summer and winter.

As we slowly walk into the Labyrinth, we flicker in and out of the light, crossing and recrossing between the dualities, pilgrims walking through the cycle of seasons and years. As usual, there is a sense of separating from ordinary, daily life and aligning ourselves to the larger frames of the natural world of seasons, sun, month, growing things and of the world of meanings, what it is important, why we are here, and so on. Anna’s husband Jim, a natural philosopher, wonders what would happen is politicians had to walk the labyrinth before deciding important matters, like going to war.

Reaching the center, my mom quietly turns to face north, east, south and west. The rest of us touch the Mother and Father stones and do whatever our personal labyrinth rituals are. Around this, we talk and occasionally joke in a quiet manner; we take the Labyrinth seriously but not necessarily solemnly. Jim remembers the last ritual here, 6 months ago, on the summer solstice: “Wasn’t that a real party, a real celebration of life?,” he says, referring to the ceremony in which my dad’s ashes were scattered. Half a year has turned since then, and that means that it has been three-quarters of a year since my dad died, on the last vernal equinox. I had to miss last summer’s ash-scattering, but I think of the small shrine I’ve made in my study in Toledo, with its small vial of my dad’s ashes. It has been three seasons since my dad died; we still have another season to traverse before we reach the first anniversary. I recognize in the many small silences that have fallen among us over the past days that we are still grieving and still learning how to deal with the large Silence left by my dad’s passing. One of the many gifts of the Labyrinth, is the freedom it gives to walk together our separate paths, in and out, through light and dark, without needing to say anything.

Standing in the center, we take photographs of different combinations of us (this, too, is one of labyrinth rituals), then we walk out of the Labyrinth, and outward into our separate lives. As we go, we carry within us the sense of stillness, shining like the bright winter stars, until we meet again to walk the Labyrinth together, in another of its many incarnations.

New Beginnings: Waking at Murray Creek

Entry for 27 December 2006 (Murray Creek):

About 6:30am, I open my eyes to the silhouette of an oak tree, framed by the large east window of my mom’s new sleeping porch in the upper house at Murray Creek. It has been raining all night, which is great, because Northern California is behind on its rainfall for the season. Today the creek will be running full again, and over the next weeks the green will deepen. It’s made for a peaceful night’s sleep, to the beat of rain on the new roof.

California live oaks are evergreen and have a marvellous irregular, spreading branch structure. Now, silhouetted against the gradually lighting eastern sky, almost 90 minutes ahead of sunrise this time of year in Glasgow, the branches form a pattern like the view from space of some great, richly brachiated river underneath clouds of leaves.

We’ve just initiated the new sleeping porch, which is not even fully finished. There are two houses on the property here at Murray Creek. For many years, the upper house, where we are now and where my mom lives now, was a guest house for visiting family, while my parents lived in the lower house.

Then, last March, while my father was in the terminal stages of the lung cancer that he would die from just a few weeks later, there was a freak 18-inch snowstorm here. The huge oak tree in front of the upper house went down under the weight of the wet snow. It didn’t hit anything, but the enormous root system underneath old sleeping porch came up out of the ground, pulling this part of the house off its foundation, ripping it loose from the rest of the house, and leaving a gaping chasm and exposing the house to the elements.

My brother-in-law Jim Madden is a building contractor, so over the past 5 months, with help from my brothers Willy and Joseph and various subcontractors, he has demolished the old porch, laid new foundations, put in double glazed windows and doors, and framed, roofed, wired, and sheet-rocked (dry-walled) the new, larger porch. It still needs a few finishing touches, like lights and electrical outlets, but now, jutting out into the lower canopy of the surviving oaks, it feels like living in a childhood dream of a treehouse.

As the light grows, we see the grey green moss and lichen encrustations of the north side of the deciduous oaks, livid against the wet, dark bark. Like the Murray Creek Valley, we have been through a lot over the past year: birth and death, destruction and reconstruction, marriage and retirement, moving house (lower to upper houses, Toledo to Glasgow). Through the long night, we have been nourished and replenished by a healing rain. Now it feels like we have moved firmly and irreversibly into a time of new beginnings, with new spaces opening up in our lives, new possibilities emerging, rough-hewn or at least not fully finished, but with shapes clearly showing, like the silhouettes of the oaks against the lightening morning sky.

(Thanks to Diane and my mom for help with this entry. For more about Murray Creek and its Cretan Labyrinth, go to www.murraycreek.net.)

SCL-90-R Rasch Analysis Paper Published

Entry for 26 December 2006:

1. After several years of work and a lot of revisions, our paper on next-generation analyses of a common measure of psychological distress has finally been published, in Psychological Assessment, the most prestigious psychological measurement journal. We undertook this project in order to show researchers in clinical and counselling psychology the analytic power and usefulness of these new methods of analysis. These methods are common in educational testing but have not yet penetrated into clinical/counselling psychology. Clinical psychology, in particular, tends to be fairly conservative methodologically, and so there has been some resistance to this methods, including in my former department.

2. Personal experience. This was one of the most challenging publication processes I have been through in my career, and probably the most technical, on multiple levels: analysis procedures, organizing and presenting complex material in a clear, simple manner, dealing with large numbers of obscure technical issues raised by the reviewers, and finally at the last minute working around excessive copyright restrictions. It would have been impossible without the group of co-authors, especially my Rasch analysis colleagues from the University of Toledo School of Education: Christine Fox, Gregory Stone & Svetlana Beltyukova. They are a great group of people, smart, fun, unpretentious, supportive and passionate about psychological measurement. Working with them provided a safe haven during a difficult time for me professionally, and I am deeply grateful to them. Two of our graduate students, Jen Anderson and Xi Zhang also provided invaluable help searching and analyzing literature and helping with parts of the write up.

So here it is, in print, and it is a piece that I am proud of, one of my key publications that I hope will have a real impact on the field. The following paragraphs are a bit of a taster for the article:

3. Why I think the article is important: Psychological measurement instruments, mostly commonly self-report questionnaires, are at the heart of contemporary quantitative research in clinical and counselling psychology, including measures of psychological distress, well-being, attitudes toward treatment, personality dispositions, therapeutic alliance, and clients’ reactions to therapy sessions. Traditional methods for analyzing such measurement instruments include exploratory and confirmatory factor analysis and reliability analysis (Cronbach’s Alpha, Ebel’s Intraclass Correlation Coefficent). These methods provide answers about the number of underlying dimensions that make up the psychological construct being measured, about how well the group of items in the instrument hang together, and about items that don’t seem to doing a good job of measuring the construct.

It turns out, however, that these traditional psychometric methods use only a small proportion of the information available, and yield a fairly limited range of diagnostic feedback. Beginning in the 1960’s, Danish mathematician Georg Rasch (1960, 1980) developed a new model for social science measurement known today as the basic form of Item Response Theory (IRT), or Rasch Analysis. The underlying theory of most Rasch models specifies that useful measurement consists of a single-dimensional concept arranged in a consistent pattern (e.g., more than/less than) along an equal-interval continuum. If the data fit the Rasch model, there are various cool things that can be done with them, because they can then be interpreted in terms of abstract, equal-interval units (Bond & Fox, 2001). This makes them “ruler-like”.

4. Eight cool things you can do with Rasch Analysis:

1. Scale points. Determine number and anchoring of scale points.
2. Internal reliability/scale length. Improve scale internal consistency and efficiency by dropping unnecessary scale points and misfitting items. (Note: Traditional approach can do this, but Rasch analysis has broader range and more precise methods.)
3. Respondent validity assessment. Identify individual respondents whose inconsistent (“misfitting”) patterns of responding indicate that their data are invalid.
4. Separation/range. Evaluate the number of distincts groups or strata of within your items (item separation) and population (person separation) that the measure can discriminate.
5. Construct validity (order/fit). Use Person-Item map (ranking of items and people on the measured dimension) and fit statistics to evaluate construct validity of measure in relation to the expected hierarchical structure of the variable.
6. Measurement gaps. Identify measurement gaps (and redundancies) on the variable in need of additional items.
7. Sampling gaps. Identify sampling gaps (and redundancies) on the variable in the need of further research.
8. Theory testing and development. Test and refine theories about sequence, development, rank of constructs (by use of order analyses).

5. Article abstract (Warning: The following is the official summary of the article, but it’s pretty dense and technical. We spent a lot of time getting as much information as possible into the 125-word limit, like some sort of warped mega-haiku, only less poetic.)

Rasch analysis was used to illustrate the usefulness of item-level analyses for evaluating a common therapy outcome measure of general clinical distress, the Symptom Checklist-90-Revised (SCL-90-R, Derogatis, 1994). Using complementary therapy research samples, we found that the instrument’s 5-point rating scale exceeded clients’ ability to make reliable discriminations and could be improved by collapsing it into a 3-point version (combining scales points 1 with 2 and 3 with 4). This, plus removing three misfitting items, increased person separation from 4.90 to 5.07 and item separation from 7.76 to 8.52 (resulting in alphas of .96 and .99 respectively). Some SCL-90-R subscales had low internal-consistency reliabilities; SCL-90-R items can be used to define one factor of general clinical distress that is generally stable across both samples, with two small residual factors.

6. References:
Article: Elliott, R., Fox, C.M., Beltyukova, S.A., Stone, G.E., Gunderson, J., & Zhang, Xi. (2006). Deconstructing therapy outcome measurement with Rasch analysis: The SCL-90-R. Psychological Assessment, 18, 359-372.
General: Bond, T.G., & Fox, C.M. (2001). Applying the Rasch Model: Fundamental Measurement in the Human Sciences. Mahwah, NJ: Lawrence Erlbaum Associates.

Californias Old and New

Entry for 24 December 2006, Christmas Eve (Pleasanton, California):

I wake again about 5am, from a combination of jet lag and an annoying cough, the latest stage of the first cold I’ve had in months. (It must be the lack of rain!)

As I lay there, I muse again on the similarities between Northern California and Scotland, which was the theme of the opening entry of this blog, last September, only this time from the perspective of Northern California. In what senses is Scotland a new California for me?

Like central Scotland, Northern California is green now. Actually, Scotland is a wee bit greener right now, because here in the north of California it is not as green as it sometimes is in late December. The rains have come, but total rainfall is still low for the year. The average rainfall for this part of Northern California is a total of about 19 inches/year. The comparable figure for Glasgow is 44 inches. But still it is green rather than brown as in Midwest in winter.

The traffic is also pretty bad, as the roads of Northern California, like Glasgow, get more crowded with each passing year. Partial compensation is that drivers are reasonably polite in both places.

The Scottish Borders area south of Glasgow reminds me of the California coast range south of San Francisco: It consists of small mountains and rolling hills, not much developed and primarily given to livestock herding. I spent a lot of time in this part of California as a child, and find it similar in look and feel to Scottish Borders. I think that this is the part of Scotland that my dad resonated with so strongly. And of course, it is where the Elliott clan comes from.

North of San Francisco and east up into the Sierra Nevada, Northern California becomes wilder and more rugged, like the Highlands of Scotland.

California is regarded by outsiders as “the land of fruit and nuts,” but like Scotland it is a complex culture. The Native Americans were long ago driven off the land, like the Scots Gaels and crofters of the 19th Century Highland Clearances. Their presence hangs over both places like ancient ghosts. Successive waves of migration brought many other ethnic groups: First, the Irish, then people from the Indian subcontinent and elsewhere, to Scotland; first the Mexicans, then later Northern Europeans (including many Scots) and many others, to Northern California.

However, California, especially the Central Valley where I grew up, has a deeply conservative, fundamentalist population that is remarkably Calvinist. And Scotland is famous for its Socialist politics and has no shortage of people with exotic and new age-y interests. In fact, the Person Centred counselling community in Scotland feels very familiar to me from my youth in the Human Potential movement of the 1960’s and ‘70’s. This is no accident, of course, because California is where Carl Rogers gravitated to for the last 20 years of his life.

So now we are in Old California, and in various ways it we continue to experience the parallels between our old and new lives and places. To quote T.S. Eliot, “In my end is my beginning.”

Aspects of Causal Inference

Entry for 22 December 2006 (flying to California):

Much of what is emerging these days in my emotional and intellectual life comes in the early morning between sleep and waking, in the form of dreams and reveries. Two weeks ago I dreamed I had found a multidimensional framework for organizing causal inference, a key issue in psychotherapy outcome research. But I was thrust immediately into daily activities and was unable to write it down, and it faded from awareness. Then, a week ago, I was laying half-awake, and this dream came back to me. I lay there for an hour drifting in and out of consciousness, exploring and elaborating the framework, then, I got up and spent an hour making notes on the framework. I wrote the following entry as we flew to California today:

The starting point for this framework is the observation that different aspects of causal inference are typically confounded with each other in discussions about psychotherapy outcome, particularly in translating research into policy recommendations, such as when policy bodies try to making lists of empirical supported/evidence based psychotherapies. However, there are at least 3 different aspects of inference that have to be made and justified:
I. The type or level of causal inference being made (weak, strong, or deep)
II. The likelihood that a relationship is the case in a particular instance (surety)
III. The prevalence of the relationship in the population (breadth)

I. Type or level of causal inference:
A. Weak or change-related causal inference: Is this therapy related to client change? This simplifies to, Did the client change over the course of therapy? This concept parallel the following methodological formulations:
1. The first two conditions of causal inference in causal condition theories such as J.S. Mill; Haynes & O’Brien (2000), which state that necessary preconditions for making a causal inference are that there be some sort of association between cause and effect and that the supposed cause must precede the effect. In causal modelling, these are the conditions for a weak causal order.
2. Statistical Conclusion Validity in Cook & Campbell’s (1979) theory of design validity: Again, that there be a statistical correlation between cause and effect.
3. Change vs. nonchange explanations in Hermeneutic Single Case Efficacy Design (HSCED; Elliott, 2001, 2002): The first question in systematic single case studies of therapy: Did the client really did change over the course of therapy? (This establishes the existence of a correlation and an appropriate temporal order between cause and effect.)
4. In psychotherapy research, relevant ideas are: effectiveness research; reliable change; pre-post significance testing and effect size analysis; open clinical trials.

B. Strong or change-production causal inference: Does this therapy cause client change? In other words, is it responsible for observed client change? However, this question needs more unpacking, because we are not talking about mechanistic change. Clients are not billiard balls, and therapies (and therapists) are not pool sticks! In general, it is more precise to say that clients make use of therapy to change themselves, so a better version of this question might be: Does this therapy successfully provide this client(s) with useful opportunities to change themselves?
1. This inference involves a third condition of general causal inference: the ability to rule out reasonable alternative causes to one’s favored cause.
2. This corresponds to Cook & Campbell’s internal validity, that is, the ability to infer a causal relationship between cause and effect by ruling out plausible alternative causes.
3. Therapy vs. nontherapy explanations in HSCED, the second research question to be addressed in systematic single case studies: Did therapy make a substantial contribution to client change?
4. Relevant concepts in psychotherapy research: efficacy research, randomized clinical trials, no-treatment and alternative treatment control groups.

C. Deep or explanatory causal inference: Strong causal inference is empty, pointing to the existence of a causal relationship without specifying how the causal relationship works. So the question is, What is the nature of the process by which therapy brings about (or helps clients bring about) change? Or: What particular processes in this therapy (and preferably specified by the therapy’s theory) lead to change?
1. This inference corresponds to the 4th condition of general causal inference, that is, the existence of a plausible explanation for the relationship.
2. In Cook & Campbell, this condition is described as construct validity of causes, that is, what is the true nature of the cause, as opposed to its theorized nature?
3. In HSCED, deep or substantive inference is addressed by the third research question: What processes in therapy and outside it were responsible for the observed client change? Researchers then construct a narrative tying the different reasonable causal processes together.
4. In psychotherapy research research, the relevant concepts are: change process research, process-outcome research, dismantling and additive designs, and treatment adherence.

II. Inferential Probability (surety): Each of the three types or levels of inference requires a separate judgement or inference, and each has a separate probability associated with it: change-related, change-production, and explanatory inference. These probabilities can be quantified on a 0 to 100% scale, but useful phrases can be attached to different quantitative levels:
A. 10-50%: Possible: This means that the inference could be true, but is not likely.
B. 51- 80%: Likely: More probable than not. All things being equal, in the absence of countervailing evidence, where action is needed, this inference is worth making, that is, it is better than nothing.
C. 81 – 95%: Highly likely: A good basis for action in practical situations, but by no means certain.
D. 96-99%: Almost certain: This is the standard probability level in the social sciences. If you want to make an inference that is almost certain to be true, being wrong only 1 – 4 % of the time seems reasonable.

III. Population Probability Inference (breadth). Levels and probabilities of inference also apply across people/clients. In other words, for what proportion of people do these inferences hold? Alternatively, How far can we generalize our inferences? This corresponds to: (1) External validity in Cook & Campbell’s design theory, which refers to the extent to which causal inferences can be generalized to populations of interest. (2) Case precedence standards in legalistic research models such as HSCED. (3) In psychotherapy research, health services research, moderator research, replication, best practices standards are the corresponding concepts. Population probabilities can also be expressed quantitatively, from 0 to 100%, but different ranges of probability can be usefully distinguished:
A. Possible: Inferred successfully in 1 or 2 cases; possibly efficacious; based on a minimum precedent.
B. Probable: Inferred successfully in more than half (> 50%) of some reasonable number of cases (5? 9? 21?).
C. General: Inferred successfully in most (> 80%) cases.
D. Almost invariable: Inferred successfully all or almost all cases (> 95%).

Implications:

When would we be justified in saying that only therapy X should be offered for a particular client condition? I think that this would require a whole set of inferences: weak, strong, deep, sure and broad. That is, we would want to be almost certain (II.D) that almost all (III.D) clients changed (I.A), that their change was due to therapy (I.B.) and that we understood why (I.C.). Such a rigorous standard should be required in order to go against established bodies or knowledge supporting other approaches and also against considerations of client choice.

On the other hand, in busy practice settings where little is known and where action is required, it would be enough for us to infer that client change (I.A., weak causal inference) is likely (> 50%; II.B.) in at least half of clients (III.B.).

Finally, if the situation was desperate, as is often the case in the treatment of advanced stages of cancer, client change (I.A.) at reduced probabilities (up to 50%; II.A.) and for only one or two clients (III.A.) might suffice. This would not be ideal of course, but it is possible to imagine situations in which it would be the most ethical course of action.

Winter Solstice: Return to the Beginning

Entry for 21 December 2006 (Toledo):

Light rain, almost smirr but without the wind to blow it into our faces; new moon at the winter solstice, reaching the maximum point of the Dark, 7:22pm tonight. From this moment, the sun begins its journey north again, and the light prepares to return, at first imperceptibly, then more rapidly as spring approaches.

Streets full of Christmas shopping traffic this afternoon, almost as bad a Glasgow congestion. Waiting to cross Monroe Street after going to the Barnes & Noble about 5 tonight, I had a vision of Great Western Road in Glasgow, busy with traffic.

Tired and spaced out from shopping, we throw together a dinner of leftovers and salad, then in a somewhat desultory fashion, with many distractions and some disorganization, begin packing for California, in preparation for our departure early tomorrow morning. Finally, a bit ago, Kenneth presents Diane with a belated birthday present: a hand-cranked nut-grinder, which pleases her greatly, a gift worthy of carrying back to Scotland with us.

We are not quite ready for Christmas, but we are getting there and I think will be ready for it when it arrives. Although we are not particularly wise people, we have travelled afar from out of the East, and will travel further west yet, until we arrive at the place where we began: Northern California and family. Diane and I grew to maturity there, and I lived the first half of my life there. So it is always good to return to our ur-home, the home of our homes: California: Toledo: Scotland. We carry all of these homes in our heads and hearts, homing toward them, as the year reaches its darkest point and begins to turn to the light again.

Back to Toledo

Entry for 20 December 2006 (Toledo):

It has been beautiful here in Toledo since we arrived, crisp but clear and sunny, which looks even better after 5 weeks of Scottish rain. We are enjoying having two more hours of sun per day than Scotland is currently getting. We have been spending much of our time sorting out the accumulated piles of mail that needs attention, doing some Christmas shopping, continuing to replace my stolen identification and bank cards, and waiting for our kids to show up.

Tonight they arrived, and we had a fine time fixing dinner, eating and joking together, including a low-key belated birthday celebration for Diane and Kenneth, followed by a session playing tennis and bowling on Brendan’s new Wii (pronounced "wee") game system, in which each person has a motion-sensitive remote controller that you use as a tennis racket, bowling ball, etc. As I write this, I hear their voices downstairs, frequently rising in laughter. Over the past months, I have missed the sense of community we have together; this makes it all the more lovely now.

Curiously, the small remote control unit is referred to as a "Wii controller", which in fact it is. Now we have yet another homonym for /we/: we, wee, whee!, wii...

Dreaming of Scotland

Entry for 18 December 2006 (in Toledo, Ohio):

I awake about 4 am from a long, vaguely remembered dream, thinking for a moment that I am still back in Scotland. However, the bed is too comfortable (no mattress springs to prod me as in the cheap bed in our Fulton Street place). I open my eyes: there is a delicious moment of disorientation, a kind of swirling, then the room suddenly settles out of intercontinental quantum uncertainty, condensing into my bedroom in our old house in Toledo.

I get up to go to the bathroom and get a bottle of water; the air is drier than I’m used to from our forced air central furnace and I seem to be coming down with a sore throat. When I go back to bed, I find that my body doesn’t want to go back to sleep. East-west jet lag has struck again!

As I lie there trying to relax, I remember the general content of what I’d been dreaming: The familiar, pale Scottish faces of the colleagues with whom I have been working; the sense of familiarity and comfortable ease.

Eventually, after an hour or so, I manage to drift off, into more dreams of Scotland: This time, we are gathered for Burns Night (25 Jan)ffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffffff [Here I drift off as I write this entry, mid-blog, with my left index finger on the “f” key – this happens quite a bit.]. … Everyone is dressed up; it’s a solemn occasion, full of ritual. As it continues, various things happen that I have so far only heard about: The speech to the haggis, the dagger, the reading of poetry; it’s all there. When I wake up again, the sense of happiness lingers for a while into the day. I feel more rested and better than I expected to.

Emotion scheme analysis:
1. Emotional core: happiness/comfort, feeling at ease.
2. Perceptual-situational: Getting an email about Burns Night a couple of days ago; the Unit party on Thurs; surviving my first term in my new job.
3. Body-expressive: A relaxed, loose feeling in my shoulders, arms.
4. Conceptual-symbolic: Identity: identifying with my Scottish ethnic identity/ancestry/new work situation. Verbal commentary: “I must be getting used to living in Scotland.” Metaphor: Dreaming about Scotland is like dreaming in another language; it means one is finally learning at a deeper level.
5. Action tendency: Wish: To stay connected with my life in Scotland during the coming weeks away; email Lorna about Burns Nights, decide which celebration to attend (both?).

Tis the Season for Course Meetings and Christmas Meals

Entry for 17 December 2006(in flight back to USA):

This week has felt like staggering from one long meeting or holiday meal to another. These appear to be the joint signs of the season in Scottish academic culture. I had 10 hours this week of meetings with fellow members of teaching staff, to review the term just completed. The MSc course staff members met on Tuesday, then on Thursday there was an all-day meeting of the Counselling Diploma course staff. These meetings differed greatly in their structure, size, amount of interpersonal processing, content and so on. Both were very productive in terms of providing useful opportunities to take stock and to think into the future.

The Diploma course meeting was longer and less task-focused. However, the contrast to my first exposure to Counselling Unit course meeting process last summer was striking. At the two meetings I attended in late June and early July, it was clear that morale was low. Many of the part-time tutors complained that the changes due to staff turnover had not been properly assimilated and that they felt adrift, cut-off and not “held” by Unit management. From Thursday’s meeting, nevertheless, it is clear that we have come a long way since last summer. Although there have been various crises and stresses over the past months and many of us do feel stressed, we have new staff and new energy, and the training in all three courses appears to be going well. Morale is high and we are looking forward to the rest of the academic year. New, excitingly developments are afoot. After Thursday’s meeting, I felt ready to celebrate

This was a good thing, because celebration was definitely on the agenda for the week, as various celebratory meals followed one another relentlessly. First (to back up for a moment), on Wednesday, I took Diane out for a birthday lunch at a very nice Scottish restaurant, An Lochan, which we have been to last Summer (under its old name, Café Royale). Then, to cap Thursday’s all-day Diploma course meeting, there was the annual Counselling Unit Christmas dinner, this time at The Windows, a restaurant on the 7th floor of the Carlton George Hotel, near to Georges Square. There were Christmas crackers; I ordered turkey and fixings (having missed my Turkey Experience by being in Italy for Thanksgiving this year). Far below, the wet streets reflected back the Christmas lights. I remembered how I had met most of the staff last year at this same holiday meal, after a lonely and stressful week of waiting for my job interview here. We have all traveled far in the past year!

On Friday I went for the holiday midday meal organized by the Fulltime Diploma course students. This was at a restaurant in the West End named The Primary (because it used to be a primary school). This took most of the afternoon, and I had no sooner arrived home, before we had to turn around and go back out to meet Dave and Elke at Wagamama (the Japanese-noodle-style restaurant mentioned in my blog previous entry, “The Dark”). By this time, I was sure that I couldn’t eat another bite, but I managed to find room for a salad, miso soup and some edemame (and their unlikely but delicious chili pavlova parfait for dessert…).

The week began to feel like some sort of medieval Trial by Festive Meals. We have been enjoying the generally smaller portions served in restaurants here, after suffering the inflated serving sizes favored in American restaurants. However, since it is the holiday seasons, all bets are now off, and the servings are Truly American in their over-the-top overabundance. Thus, it came as a great relief to be able to eat normally on Saturday.

Finally, it was off to the annual Christmas concert at Barony Hall. This is a fine redstone 19th century gothic revival church at the top of High Street, near Glasgow Cathedral. Over the past 50 years, the drastic decline in church attendance across Scotland (as in much of Europe) has forced many fine old churches to close for want of parishioners. In the best scenario, these churches have been desanctified and converted into performance spaces, that is, temples to the performing arts. In this case, the University of Strathclyde spent 3 million pounds to clean the red sandstone (darkened from industrial pollution), make the nave into an effective performance space, and build a pavilion to connect to old church hall to the nave, making large reception area.

The concert was performed by Capella Nova, an excellent local group specializing in Scottish medieval and contemporary vocal music, assisted by a visiting brass quintet from Saint Petersburg, Russia, who were also in fine Slavic form. We were perched up in the transept loft looking down on the musicians from the side. The program was an entertaining blend of traditional, medieval, modern and popular music, complete with audience participation in singing several familiar carols. At the intermission, the audience was treated to the two staples of UK seasonal celebrations: mincemeat and mulled wine. All in all this was a lovely end to a demanding week of meeting and celebrating!


Footnote: The Bear. Part of the tradition of Unit’s holiday meal is a blind gift exchange. In a kind of poetic justice, I received a teddy bear wearing a shirt that said “Scotland” on it. In 1985, while traveling with Brendan, Diane, my Dad and my sister Louisa, Brendan left behind a similar teddy bear at a bed and breakfast place somewhere south of Glasgow (I can’t remember exactly where now). This teddy bear had been given to me by a former girlfriend from the University of Santa Cruz, and I had passed it on to Brendan on a kind of extended loan. With the loss of the teddy bear, I felt as though I had lost part of my youth. For many years I looked without success for another copy of the same teddy bear. Now, after another turning of my life, out of the blue I had received a replacement for the Missing Bear. Not the same bear, but a new one, emblazoned with the name of my new country.

True Nature of the MSc course in Counselling Revealed

Entry for 17 December 2006:

The MSc course meeting last Thursday was small but very useful in terms of reviewing student progress and making decisions to further the effectiveness of this still-relatively new course. I may be slow, but the education system is different enough here that it has taken me a quite awhile to understood this course. However, if I think of it as the second part of the two-part masters’ degree course, it helps a lot:

The first part of the masters’ degree is the Counselling Diploma course that I have been teaching on this term. This is equivalent to the coursework component of a US masters degree program, only everything is team-taught. This has the effect of putting all the program content into a blender and mixing it into a kind of postgraduate soup. Although students are encouraged to apply to go on to complete the second part, they don’t have to, and in fact most don’t.

The second part is basically a masters’ thesis course. That is, a group of thesis students are supervised primarily in a group format by a team of tutors. Students do occasionally meet individually with their thesis supervisors, but most of the input is done in the research supervision group. To confuse matters, they call the masters thesis a “dissertation.” (in North America, “dissertation” is a word reserved for doctoral theses.) The combination of the Diploma course’s intensive therapy/counselling training and the research thesis/dissertation makes for a nice package, which I am confident we can improve still further by increasing the coherence between the two parts.

Further, now that I have translated the course structure into more familiar terms, it will be much easier to think strategically about how to contribute to the different parts. Better late than never!

Social Anxiety: An Personal Account

Entry for 12 December 2006:

In Heuristic Inquiry, Clark Moustakis’ approach to qualitative phenomenological research, researchers begin by studying their own experience. (In some cases, they end there also, a practice I find highly dubious, but that is a matter for another day…) When the Social Anxiety Study Group had its first meeting, we agreed that this would be a good starting place, so we undertook to write about our own personal experiences of social anxiety, trying to answer the following questions in 2 – 4 pages:
1. What was the experience was like for me?
2. What do I understand to have been the sources or causes of my anxiety and related difficulties?
3. What have I found useful in helping me cope with SA and related difficulties?
4. What have I found to be not helpful or even hindering for my dealing with SA and related difficulties?The following is my own account:

Description of my experience of social anxiety: I remember being painfully shy as a boy. I don’t remember when this began, but my clearest memories of feeling anxious around other people – especially other kids – are from ages 6 to 13. In retrospect, I suspect that a large part of the problem was that I was also a show-off who couldn’t keep his mouth shut, so I often put myself in embarrassing situations in which I was made fun of by other kids or just felt like I stuck out.

In its worst, most paralyzing, form, I experienced this anxiety as a painful self-consciousness. I felt like I was standing outside myself, watching myself and everything I did. In particular, I was aware of how awkward and strange I looked to others: Glasses, big ears, funny hair, runny nose, pigeon-toed, awkward, thin, no muscles. I imagined that others looked at me and judged me as odd and not belonging. I felt cut off from other people, and it was hard to believe that others might want to be my friend or ever be romantically interested in me. I felt like I was performing a role, in an obvious, awkward manner that was obvious to everyone. I was terrified of doing really stupid things, like committing social blunders such as going to the wrong classroom or saying something stupid. If I wanted to say something in class, my heart would pound while I waited to be called on, and I would sometimes find that my anxiety drove whatever I wanted to say out of my mind by the time I was called on, leaving me gasping like a fish out of water, with nothing to say.

Perceived sources of social anxiety. Most obviously, I was anxious about people judging me as inadequate in various ways: stupid, funny-looking, awkward, weird. As I said, it might have been OK for me to have been all these things if I hadn’t cared what other people thought of me, or if I hadn’t wanted them to like me. Then I could have just ignored them and been content to do my own thing, which was to read voraciously and to act out elaborate scenarios with my toy animals and soldiers.

Unfortunately, I also wanted to be liked to and to have friends, to part of a group of people, or, failing that, to impress them with how smart I was. Since I was very bright, I often tried to gain adult approval by showing my peers and teachers how much I knew. This of course resulted in my being socially isolated by other kids as a “brain.” (To this day, I am highly ambivalent about others’ praise, both desiring it and being uncomfortable with it, perhaps because it is linked to social rejection in my experience.) As a result, I often felt lonely and friendless. (In fact, I did have a few friends with whom I played regularly, but didn’t seem to matter.)

In short, I felt miserable and didn’t like myself at all, while at the very same time secretly harboring the idea that I was somehow special and maybe even better in some way than most of my peers. All of this tied me in knots of conflict and led to considerable feelings of anxiety about interactions with other people, especially other kids.

I have often wondered where these feelings came from. At one time, during my early adulthood, my parents guiltily held the theory that they had somehow made a mess of me because of their own inexperience and inadequacy as young parents. However, this theory never appealed to me; in fact, I found it insulting! On the other hand, there was a strong value put on being different in my family, and we tended to believe that we were somehow different from other people. Actually, we implicitly believed that we were better than other people, but never admitted this explicitly, as it would have been arrogant to do so. This ideology of nonconformity now seems to me linked to my anxiety about being judged and rejected by my peers: I wanted to be different (in good ways), but at the same I was afraid I was different (in bad ways). I wanted to be liked and accepted, but I was awkward and tended to act superior to others, which put them off.

Some of these feelings of self-consciousness and perceived/feared judgment and rejection by others lasted into adult situations in which I had to present or perform in front of other people. Thus, I was especially anxious when I first began doing public speaking and teaching, and when I first began presenting at scientific conferences, in my late 20’s.

What helped me deal with my social anxiety. What kept me going and sustained me during this difficult period of my middle childhood was my pride in my intellectual ability and the sense that my family was somehow special. One turning point occurred at age 9, when a psychologist gave me an intelligence test, and recommended me for the gifted program. In my mind, this validated the sense of specialness that had been communicated by my family. I felt that I had been “discovered”, and for years felt a special sense of gratitude toward this psychologist. Another turning point occurred when my grandmother took me to Europe with her the summer I turned 13. I came back feeling more sophisticated and special, and immediately started high school, where I encountered and became an active part of a group of kids who were like me in many ways (and who would be called “nerds” today). At this point, I finally found a group that I could be part of. This activated the intellectually and socially ambitious part of me, and I organized my first social-intellectual organization with my friends, called “United Terrans”.

Later milestones included taking public speaking during my senior year in high school, developing a peer research group in graduate school, beginning teaching, and being introduced (by David Shapiro) to overhead transparency technology for presentations and teaching. The later technology enabled me to stop reading presentations and to begin interacting with my audience. (I am always more comfortable if there is some kind of interaction with my audience, even if it’s challenging.)

What didn’t help me deal with my social anxiety. What didn’t work for me was telling myself not to feel anxious. (Although looking myself in the mirror and telling myself I liked me did help a bit.) My parents’ suggestion that I would “grow out of it” the one time I tried to explain it to them also didn’t help, but only made me feel more isolated. From where I am now in my life, I also don’t think that exposing myself to social situations before I achieved an adequate level of self-esteem would have been helpful. Afterall, I continued to do things that caused me embarrassment throughout this period, without it really affecting how I felt. Instead, it seems important that I developed a sense of legitimate, socially-validated ‘specialness” and social belonging first.

Concluding reflections. It is clear to me now that my deep need to connect with other people and to be part of a group was both the source of much of my misery, and the eventual route of my overcoming my social anxiety. In other words, through it all, I still felt this deep hunger for connection, which made me feel lonely when it wasn’t happening, but which continually drove me to seek to connect with others until I at last succeeded. Although the idea of retreating from the world and becoming a hermit always had intellectual appeal to me, I continually found it to be impossible for me. So I continued to be anxious until I felt truly validated and became part of a community of people like me.

In the end, there seems to be something in me that always tries to connect to others. This is of course why I eventually became a therapist, and why I always want to know the client’s experience in my research. In other words, in spite of being afraid of being judged by others, I continued to try to connect with them until I eventually succeeded. And when I succeeded in connecting with others, my individual self receded far enough into the background that it didn’t occur to me to be anxious about what they would think of me. I was too busy being with them!

The Dark

Entry for 9 December 2006:

Americans usually visit Scotland in the summer, so the Scotland they fall in love with and idealize is the Scotland of the endless summer days with long evenings and mild weather when it doesn’t rain all the time, but is still lovely and green. This is a sunny, bright, friendly Scotland, Scotland the bonny (=pretty, excellent) and braw (=brave, fine, showy).

But there is another Scotland: the dark, cold, wet, and mean. Sunrise this time of year, is 8:30 or later; sunset is about 3:45 in the afternoon. When it is cloudy and raining, the day feels even darker and shorter. This is the Scotland that Americans don’t usually see. This is what we are living right now as we approach the winter solstice, as the days draw in increasingly and the temperatures drop into the 30’s (F = 0 to 5 C). In this Dark Time, the dark side of Scotland and the Scottish people emerge: drinking, depression (Seasonal Affective Disorder), bullying and vandalism.

We experienced this duality strongly today: The day was clear for a change and bright, quite unusually, given how much rain we’ve been getting. This afternoon, we went into the city centre to do a bit of Christmas shopping and before we knew it, it was dark. We headed for George Square, where this year’s Christmas lights were even more overdone that I had remembered them from this year last year (when I came for my job interview). The place was swarming with families, drawn like us to the bright lights and excitement of the holiday carnival there, rides and portable ice rink packed with people skating in circles on high-heeled skates. These lights, like those at the Christmas party we went to last night, seem to be lit against the Dark.

After that, it was on through the dark as the shops around us shut at 6 pm, to Wagamama, a kind of Japanese noodle place, bright and buzzing with people packed around communal dining tables, where Diane struck up animated, friendly conversations with strangers on both sides of us. We left feeling light and happy and took the train back to Anniesland, a set of brightly-lit rooms moving through the dark toward home.

At Partick, a woman of middle years got on the train with her 7 or 8-year-old daughter. The woman kept grimacing with pain, muttering, hiding her head, occasionally smiling briefly, unable to keep still; meanwhile, her daughter kept looking around nervously at the other passengers to see if they were watching. Before we arrived in Anniesland 5 minutes later, it was clear to Diane and I that the woman was experiencing a psychotic episode. We were a facing another sort of Dark, familiar to us from our work in mental health, but in a situation where we felt unable to offer help, if only because we had no idea where to direct the woman and her daughter.

From the Anniesland train stations, we made our way home. Then, stopping to at the convenience store on Fulton Street, a couple of blocks from our house, we were accosted by a group of 5-6 young people standing around outside the store, drinking. As we approached they caught sight of my distinctive black outback hat and started yelling at me, “Yeehaw, cowboy!” Annoyed, I was muttering, “It’s Australian!”, when one young woman reached up and tried with all her strength to rip the hat from my head. Instantly, I clapped my right arm onto my hat and pulled back with my body as hard as I could, while we pushed our way through the doors and into the store. The group of young people laughed outside. In the instant of reflexively protecting my beloved hat, several things had happened at once: First, I had strained my right arm again, which has been hurting on and off for the past two months; during the incident, I had had to fight not only against the young woman’s strong grip but also against the pain from the re-injury, which was now throbbing. Second, noticing a bottle of something alcoholic-looking in her other hand (the one she wasn’t using to take my hat), I had had to ignore the impulse to yell “You’re drunk!” in her face. I now realized that this restraint had been the wisest course of action. Third, this incident felt somehow linked to having my wallet stolen in Rome, and I wasn’t about to be victimized again, not when I could do something to stop it. This time, my anger had mobilized me to stop a violation, and it was only afterwards that I realized that I was angry.

We found our milk and paid for it. I looked at the nice Pakistani man who works at the store (and who had kept Diane’s passport for her in September), and said, “They’re a bit rowdy!” but he didn’t answer, acting as though he hadn’t understood me. He looked uncomfortable. We were going to have to run the gauntlet of people as we left, so we prepared ourselves by putting the milk away in a bag in order to have our hands free to defend ourselves. I was going to turn right to go straight through them toward our house, but Diane, wisely and firmly directed us to the left, away from our house and led us across the street, giving them a wide berth. It’s times like this when I think I have no street-sense whatsoever!

Walking home through the dark, we pondered this encounter with the Dark, practically on our doorstep. We noticed small clumps of young people wandering up and down Fulton Street on a freezing, windy Saturday night, apparently bored with nothing better to do than to drink, smoke and occasionally harass passersby. This is the mean-spirited, anarchic Dark of Scotland. I thought of the kids who threw an egg at me on Halloween a block south of the convenience store, of Lorna’s son being bullied and threatened at his rural school 20 miles away. Suddenly our neighborhood no longer seemed genially shabby and run-down, but instead seemed dangerous and Dark. Finally looking down the street us to see if we were being followed or watched, we opened the front door and went into our place, carefully locking the door behind us.

I fell asleep writing this blog entry (something that happens regularly), but when I awoke at 4 am, I lay awake for quite a while, realizing that the Pakistani man who runs the convenience store had also felt threatened by the crowd outside his store, and seeing how he was also being victimized by having his customers threatened at his doorstep. He and I are both viewed as outsiders here by alienated youth who see us as intruders. This is the Dark of prejudice and social exclusion.

Dark vs. light; mean/cynical/alienated vs. friendly/hopeful/open-hearted. This is the time we are in and the place we are in. For the past week, we have been actively looking for another place to live in Glasgow, one that has more Light in it and feels more like a community to us. Maybe that will be Milngavie, on the northern edge of the suburbs, a quaint touristy town at the beginning of the West Highland Walk, where we wandered for a couple of hours on Friday watching the families. Maybe that will be Hyndland, with its spacious 100-year-old 4-storey red sandstone buildings, crowded but neat, filled with academics, families and old people. Both places, we have been assured, are filled with people like us; either place, we hope, will have more of the Light and less of the Dark in them. But of course, Dark and Light can be found in all places; there is nothing particularly Scottish about either Light or Dark. This is only the place where we are presently encountering this universal duality in the human heart.

The University Jordanhill Staff Christmas Party

Entry for 8 December 2006:

Most of our colleagues scoffed at the idea, but Mick was intent on going to the annual (free) holiday party put on by the Education Faculty for the Jordanhill faculty and staff. I had forgotten about it until yesterday, when I finally noticed the poster in the hall, read it, and decided that it was too late to do anything about it. A couple of hours later, Mick phoned me up to tell me that he had picked up tickets for Diane and I, and would we like to meet them there at 8 or 8:30. After a quick briefing and consultation, Diane agreed to join Mick and Helen, uncertain about what we were letting ourselves in for. After all, we had stopped going to Department Christmas parties several years ago, mostly because we weren’t getting along with the people who might be there.

After a harrowing driving over to Mick and Helen’s due to an ill-advised attempt on my part to show Diane the clever backway to their house, we picked them up and took them to the University Refectory, where the party was.

At first, it appeared that I didn’t know anybody there but Mick and Helen; however, gradually, I realized that many key players I have run into over the past 3 months were there: Rachel, one of the secretaries at the Counselling Unit; Bill, the head of the Human Resources Office, hanging out with what looked like a collection of old buddies; Iain, the Dean, who has been so helpful in orienting me over these past months; Margaret, who organizes a monthly discussion group for department faculty, which I have attended a couple of time, and many others whom I found that I recognized from different contexts.

So it became a kind of reprise of my time here so far, and Diane got to meet people that I’d been talking about. Bill and I complained about the music, which was mostly Karaoke-style versions of 1970’s California-style pop rock; and he said supportive, nice things to Diane, which she appreciated. Iain told stories about Dave and hearing Amazing Grace in Tashkent. I talked about my blog. Mick bought us all drinks, and smiled a lot, genuinely happy to see all the different kinds of people from the University talking and dancing together. Helen danced a lot, sometimes by herself when the rest of us got tired, enjoying herself in that unreserved, free way she has. Mostly, we shouted ourselves hoarse trying to make ourselves heard over the din, getting deafer as the evening progressed.

By about 11, we had hit the wall. It had been a very long day, much of it taken up looking at 3 flats and trying to figure out whether and where we are going to move. So we were exhausted, and after dancing a final set, we said goodbye and walked out into the moonlit night, tired but happy.

In retrospect, the party stood in sharp contrast to the Faculty Senate meeting I attended earlier this week: fluidly intermingled vs. rigidly hierarchical, loud vs. subdued, and so on. As Mick says, this is basically a nice place to work, and people know how to enjoy themselves and how to relate outside of externally-given structures and walls that separate them from one another. This unlikely party that we hadn’t really intended to attend came to stand for so much of what I like so much at the University of Strathclyde and about the best parts of our life here in Scotland.

First Meeting of the Social Anxiety Study Group

Entry for 6 December 2006:

Last Thursday, 30 November, the Social Anxiety Study Group had its first meeting. Thanks partly to the announcement that Susan Cornforth placed on the PCT Scotland website for us, turn-out was surprisingly good: Eleven people, including Mick, Lorna, Beth, & Tracey; several participants from the PE-EFT-2 training workshop, and several other graduates of the Strathclyde Person-Centred Counseling Diploma. This was all the more surprising, because it was a very windy, stormy night. Here are some of my notes from the meeting:

A. Our immediate goals are as follows:
1. To develop a Person-Centred/Experiential (PCE) theoretical formulation of the sources and processes involved in Social Anxiety (SA) Difficulties.
2. To develop a practice formulation for how to work with clients suffering SA difficulties from a PCE perspective.
3. To develop a research protocol for an Open Clinical Trial (one group pre-post design) of one or more PCE therapies for SA difficulties.

B. We began discussing diagnostic issues. I noted that the field is in the process of moving away from Social Phobia, the older term, to Social Anxiety. The reasons for this change are not entirely clear, but does have the effect highlighting similarities between SA and other anxiety diagnoses, such as Panic Disorder, Generalized Anxiety Disorder, and Post-traumatic Stress Disorder. We also discussed issues of diagnosis from a PCE perspective, and how it might be possible to do diagnosis without compromising client or therapist integrity or the therapeutic relationship. There is controversy about this, with some (e.g., Pete Sanders) arguing on theoretical and political grounds that psychiatric diagnosis inevitably disempowers clients and sets therapist up as socially oppressive experts. Others (e.g., Elliott) argue from experience that there are effective methods for separating diagnosis from treatment and mitigating the potentially harmful effects of diagnosis. These include:
•Using the word “difficulties” rather than “disorder”
•Contextualizing diagnosis as a social construction, for both clients and therapists
•Teaching therapists how to “leave the diagnosis at the door”
•Familiarizing oneself with the full extent of the difficulties with psychiatric diagnosis but experiencing these for oneself.

C. An important point was the value of involving mental health service users in our planning process, via liaising with support networks such as www.social-anxiety.org.uk (SA-UK). These organizations advocate for the development and use of effective treatments, currently mostly CBT, but could be valuable partners as a source of information and potentially referrals.

D. Interestingly, it became clear that most of us were past or current sufferers of Social Anxiety, the subject of our study. This is both a strength and a weakness: We can draw from our own lived experience, but we will be likely to expect the experience to be similar for others even when it’s not. In any case, this shared background makes it a good idea for us to begin with a heuristic research activity, i.e., writing 2 – 4 pages about our own personal experiences with social anxiety, including the following:
1. What was the experience was like for me?
2. What do I understand to have been the sources or causes of my anxiety and related difficulties?
3. What have I found useful in helping me cope with SA and related difficulties?
4. What have I found to be not helpful or even hindering for my dealing with SA and related difficulties?

New Version of Client Change Interview Schedule (IPEPPT Version, 12/06)

Entry for 5 December 2006:

This version is simpler and uses a more logical order than the previous versions. It is thus a better starting place for practice-based research protocols, including translation into other languages. In fact, I made this one in order to provide my Italian colleague, Alberto Zucconi, with a better version for translation into Italian.

See complete Instructions and record form at:
http://experiential-researchers.org/instruments/elliott/pqprocedure.html

Interview Strategy: This interview works best as a relatively unstructured empathic exploration of the client’s experience of therapy. Think of yourself as primarily trying to help the client tell you the story of his or her therapy so far. It is best if you adopt an attitude of curiosity about the topics raised in the interview, using the suggested open-ended questions plus empathic understanding responses to help the client elaborate on his/her experiences. Thus, for each question, start out in a relatively unstructured manner and only impose structure as needed. For each question, a number of alternative wordings have been suggested, but keep in mind that these may not be needed.

• Ask client to provide as many details as possible
• Use the “anything else” probe (e.g., "Are there any other changes that you have noticed?"): inquire in a nondemanding way until the client runs out of things to say

Introduction given to clients: After each phase of treatment, clients are asked to come in for an hour-long semi-structured interview. The major topics of this interview are any changes you have noticed since therapy began, what you believe may have brought about these changes, and helpful and unhelpful aspects of the therapy. The main purpose of this interview is to allow you to tell us about the therapy and the research in your own words. This information will help us to understand better how the therapy works; it will also help us to improve the therapy. This interview is audio-recorded for later transcription. Please provide as much detail as possible.

Interview Schedule:

1. General Questions: [about 5 min]
1a. How are you doing now in general?
1b. What has therapy been like for you so far? How has it felt to be in therapy?
1c. What medications are you currently on? (interviewer: record on form, including dose, how long, last adjustment, herbal remedies)

2. Changes: [about 10 min]
2a. What changes, if any, have you noticed in yourself since therapy started? (Interviewer: Reflect back change to client and write down brief versions of the changes for later. If it is helpful, you can use some of these follow-up questions: For example, Are you doing, feeling, or thinking differently from the way you did before? What specific ideas, if any, have you gotten from therapy so far, including ideas about yourself or other people? Have any changes been brought to your attention by other people?)
2b. Has anything changed for the worse for you since therapy started?
2c. Is there anything that you wanted to change that hasn’t since since therapy started?

3. Change Ratings: [about 10 min] (Go through each change and rate it on the following three scales:)
3a. For each change, please rate how much you expected it vs. were surprised by it? (Use this rating scale:)
(1) Very much expected it
(2) Somewhat expected it
(3) Neither expected nor surprised by the change
(4) Somewhat surprised by it
(5) Very much surprised by it

3b. For each change, please rate how likely you think it would have been if you hadn’t been in therapy? (Use this rating scale:)
(1) Very unlikely without therapy (clearly would not have happened)
(2) Somewhat unlikely without therapy (probably would not have happened)
(3) Neither likely nor unlikely (no way of telling)
(4) Somewhat likely without therapy (probably would have happened)
(5) Very likely without therapy (clearly would have happened anyway)

3c. How important or significant to you personally do you consider this change to be? (Use this rating scale:)
(1) Not at all important
(2) Slightly important
(3) Moderately important
(4) Very important
(5) Extremely important

4. Helpful Aspects: [about 10 min] Can you sum up what has been helpful about your therapy so far? Please give examples. (For example, general aspects, specific events)

5. Attributions: [about 5 min] In general, what do you think has caused the various changes you described? In other words, what do you think might have brought them about? (Including things both outside of therapy and in therapy)

6. Resources: [about 5 min]
6a. What personal strengths do you think have helped you make use of therapy to deal with your problems? (what you’re good at, personal qualities)
6b. What things in your current life situation have helped you make use of therapy to deal with your problems? (family, job, relationships, living arrangements)

7. Problematic Aspects: [about 5 min]
7a. What kinds of things about the therapy have been hindering, unhelpful, negative or disappointing for you? (For example, general aspects. specific events)
7b. Were there things in the therapy which were difficult or painful but still OK or perhaps helpful? What were they?
7c. Has anything been missing from your treatment? (What would make/have made your therapy more effective or helpful?)

8. Limitations: [about 5 min]
8a. What personal weaknesses do you think have made it harder for you to use therapy to deal with your problems? (things about you as a person)
8b. What things in your life situation have made it harder for you to use therapy to deal with your problems? (family, job, relationships, living arrangements)

9. Suggestions. [about 5 min] Do you have any suggestions for us, regarding the research or the therapy? Do you have anything else that you want to tell me?

Labels Feature Added

Entry for December 3, 2006:

Because different readers are likely to have different interests, I have added labels to each entry for different kinds of contents, so that readers with focused interests can select what they are interested in without having to wade through the rest. As the Labels list indicates, each entry is now labelled with one or more content labels. You can also click on a particular label in order to display only those entries. For example, if you are interested in therapy entries only, you can click on the "Therapy" label, to select these entries and hide the rest. (Thanks to Brendan Elliott and Mathias Dekeyser for encouraging me to make the switch to Blogger-Beta in order to make this change.)

St. Andrew’s Day

Entry for 30 November 2006:

One of my family’s many eccentricities over the years was the celebration of half-birthdays. Since my birthday is the last day of May, I consider the last day of November to be my half-birthday. Thus, I was delighted to learn that the 30th of November is the feast day of the patron saint of Scotland, St. Andrew, a fisherman by trade and one the original 12 apostles. He is most famous for having been crucified not on a standard Roman cross, but instead on an X-shaped cross. Legend has it that after hanging on this cross for 3 days, he was offered a pardon, but refused to let himself be taken down, insisting on martyrdom instead. To modern sensibilities such terminal stubbornness smacks suicide, or at least self-destructive pride; however, I suspect there may have been extenuating circumstances…

And one can see that this story resonates with Scottish people on several levels: Most obviously, Scots in various centuries will have found it easy to identify with a fellow fisherman. In addition, the stubbornness exemplified by the apocryphal story of his death must appeal as a metaphor for the stubborn streak that seems to be part of Scottish character. (I recognize a penchant for perverse stubbornness in myself and in my family, so I see now that we have come by this trait by way of our ethnic heritage.)

In any case, the connection to St. Andrew and his X-shaped crucifixion explains the Saltire, or Scottish national flag, a white X (otherwise known as the Cross of St. Andrew) on a blue background. A grim symbol, and also a defiant one, clashing as it does with the more conventional cross embedded in the English Union Jack. X’s are also used to cancel or cross things out, so the Scottish X also stands for a spirit of negation (which takes us back to Dave’s badgers again). It is some consolation that the patron saint of Scotland is not famous for killing a symbol of the Mother Goddess (i.e., a dragon)!

Some 1200 years after his death, St. Andrew’s purported relics were carted off to Scotland for the cathedral church in his namesake town, also the seat of the oldest university in Scotland. The town and university of St. Andrews are definitely on our list of Scottish Destinations.

But what do people do in Scotland to celebrate their favorite saint on his feast day? Essentially, they celebrate Scottishness: First, they drink and eat traditional Scottish food. Haggis is de rigeur. Since I have no taste for sheep’s guts and little taste for whiskey, I was delighted to discover the vegetarian version of haggis. (Lorna C says that the best brand of vegetarian haggis is McSweeny’s, which would delight my old friend John McSweeny, a neuropsychologist and fellow Scottish American.) This is made of lentils, what appears to be cracked barley, carrots, and pepper. The faculty refectory served a traditional-type meal of veg haggis, chopped turnips (a favorite vegetable here) and mashed potatoes. It wasn’t bad.

Second, people hear sing or play traditional music, or put on ceilidhs (social dances). While I was listening to a live concert on Radio Scotland, I remembered the Partick Folk Festival, and found that St. Andrew’s day is the excuse for a week-long celebration of Scottish trad music in various venues all over Scotland. We have made plans to attend this Saturday’s Big Day Oot concert, which is part of the Partick Folk Festival. (In the process, we learned that Partick is the traditionally Gaelic section of Glasgow, where highlanders had to go during the Clearances of the 19th Century had to stay before being transported to America and other places.)

There are serious discussions underway as part of Scottish devolution and nationalism to make St. Andrew’s Day a national holiday in Scotland. This would also aid ex-pat Americans by providing something to put in the place of Thanksgiving. We need all the holidays we can find during this dark time of year!

Modes of Engagement 2: An Interpersonal Contact Work Exercise

Entry for November 29, 2006 (Back in Glasgow):

Part 1. Introduction

We continued training in different client modes of engagement today. Last time, we did exercises on Attending and Experiential Search, using elaborations of the old Gestalt Zones of Awareness exercise.

Tonight we did an exercise on Interpersonal Contact, defined as: Working in the therapeutic relationship by revealing to the therapist hidden or private aspects of experiencing (memories of previously untold events, here & now bodily sensations or emotions, private or secret thoughts, feelings or wishes, including about therapist); trusting, opening up to therapist; being present/transparent/ real/vulnerable to the therapist; (“Here’s what is difficult for me to say to you…”).



Part 2. Exercise: Interpersonal Contact/Secret Sharing. [The following write-up is a revision of the original instructions based on what actually happened:] The point of this exercise is to reveal hidden, private, embarrassing or tender aspects of yourself by trusting or opening up to therapist or the group. As far as feels safe to you, try to be present/transparent/real/ vulnerable to the therapist or group. Here are the instructions:

a. Take out a piece of paper, and write at the top of it, “Here’s what is difficult for me to say to you…”. Then take about 5 minutes to write down any or all of the following that come to you and that you feel safe enough to possibly share.

-Previously untold events: Things that have happened to you or that you’ve done, that you’ve few people, or maybe even nobody. (Perceptual/Situational)
-Here and now body sensations: Sensations you’re aware of in your body right now that you wouldn’t necessarily tell most people. (Bodily/Expressive)
-Here & now feelings about therapist/other group members: Hard-to-share emotions you are feeling right now about the therapist/ other group members, or yourself in relationship to them. (Experienced Emotion)
-Private thoughts: Things you’re thinking to yourself (words, ideas, images) about the therapist/group members, or yourself in relationship to them, especially things that are hard to share. (Conceptual)
-Secret wishes: Secret desires, aspiration, dreams, ambitions that you generally protect by keeping them to yourself. (Motivational/Behavioral)

After you have written down your secret topics, review each one, asking yourself, “Do I feel safe enough to share this with this person/group of people tonight?” Put a star by the topics that feel safe enough to share, then pick one to share with the group/other person (you can share more than one if you want and the group decided to do that).

b. Select a format to use:
-One-to-one: Take turns sharing one or more of your secrets.
-Small groups of 5-6 people: Take turns sharing in a group.
-Group secret pooling exercise for 5-6 people: Fold your secret list twice, in quarters. Put it into a hat or other container. Mix the secret lists up. Take turns drawing one secret list. When it’s your turn, share one of the secrets with the group as if it was your own.
-Alternative one-to-one exercise: For those who do not feel comfortable with one of the above exercises, form small groups of 2 –3 and take turns exploring your sense of boundaries in therapy and other relationships: what kinds of things you feel safe sharing, what you don’t, etc.

c. In the client role: When it’s your turn, experiment with sharing one of your secrets. Pay attention to what it feels like to reveal the secret you’ve chosen to share; also, pay attention to your experience of not sharing the other secrets.

d. In the therapist/other group member role: Respond to the client in two ways: (a) By reflecting their secret back to the client in an accepting way, or (b) if you wish, by giving a self-disclosure of your own (that is, of a similar experience, of a personal reaction to what the client has said, or a personal reaction to the interaction). Note: If you choose to share a different perspective that is at variance with your client’s experience, make sure that you finish your response by adding a solid empathic response of their experience. This reduces the possibility that the client will feel judged or invalidated.

e. Take turns sharing secrets for 30 – 60 minutes, depending on the size of the group.

f. Afterwards, process the experience by discussing what it felt like to share or not share secrets. What issues came up in doing so? What did you learn from the process? How did the process unfold over time?



Part 3: Issues that may be raised by doing the Interpersonal Contact Work Exercise:

Spoiler Alert: In this part of the entry, I describe a few of the issues that may come up in doing the Interpersonal Contact exercise described in the previous blog entry. If you are planning to do this exercise in the near future, it might be best to wait until after you do so before reading this entry, in order to experience the exercise in a fresh way.

* * *


In fact, this exercise allows participants to experience what we ask clients to do in every session. Therefore, it can enhance empathy for the client’s immediate in-session experience.

The exercise also promotes experimentation with different kinds of appropriate therapist self-disclosure, including (a) Therapist Life Disclosure (also known as “me-too self-disclosure, cf. Goodman), (b) Client Content Reaction Disclosure (to the client’s story or content), or (c) Interaction Reaction Disclosure. (I am indebted to Jutta Schnellbacher at KU Leuven for formulating these kinds of therapist disclosure, including one other: Personal Clarity Disclosure about therapist intentions, limitations and therapeutic processes.)

Participants are also likely to learn more about their personal boundaries from doing the exercise, what is OK to share in each role, and what is not. Both things said and things not said are important.

Participants described a spiral process of deepening disclosure within groups. This process requires adequate time to unfold.

It is important for participants to have choices in how to participate in this exercise. In fact, participants who find that their boundaries don’t allow them to participate can get just as much from the exercise by exploring their process and experiencing the empowerment of being able to say no. For this reason, it is important to honor and support such hesitation.

The exercise does a good job of helping participants access different forms of shame. Shame is a basic, biologically significant, emotion, and can occur in a variety of forms: primary adaptive (related to maintaining connections to one’s community), primary maladaptive (overgeneralization of past humiliation to present nonevaluative situations), secondary reactive (reacting to other emotions such as anger with shame), and instrumental (deliberately displaying embarrassment in order to impress others of one’s moral character).

Italian Person-Centered Conference Dinner/ Thanksgiving in Rome/ Further Reflections on My Presentation

Entry for 25 - 26 November 2006:

In spite of the theft, we decided that we would consider the conference dinner for the Italian Person-Centered Approach Conference as our Thanksgiving feast this year. Billed as a 6-course mail, we lost track somewhere in the middle, partly because most of the courses had multiple parts to them, to whit:

1. Appetizers: 6 or 7 different appetizers deposited on our plates a random times over the space of half an hour.
2. Pasta: 3 different kinds of pasta, served onto our plates at intervals, the last a rigatoni served with a fiery red sauce called in Italian “angry sauce”. Note: The pasta is generally amazing here, the noodles have more body making the pasta we get in Scotland or America seems like pallid imitations. People offer various theories about this, ranging from not being over-cooked, to “freshness,” to the use of hard vs. soft wheat (my favorite theory).
3a. Meat: large cubes of beef, leg of lamb in chunks, both very tender and nicely seasoned.
3b. A salad of missed greens was deposited onto our meat plates. We were definitely flagging by this point. Two courses back, we had taken to trying to predict the next course. The money was on a fish course…
4. Tiramisou came as a pleasant surprise, and was lighter and more refreshing than the usual heavy version we get in the USA. More importantly, we were given the etymology of the word: it means “Pull yourself up”, or more colloquially, “Pick me up”.
5. Most people left about this point, but a few of us stayed for the dessert liquor, and we ordered something that was described as lemon peal in ethanol. Quite aromatic, and strong!
6. Either we missed something, or the salad and coffee/liquor were separate courses… or Alberto was exaggerating.

I sat next to Andre’ de Peretti, a French person-centered educator. It was so noisy, especially with the Naples group shouting from one table to the next, that we had trouble understanding each other. However, he did manage to compliment me on my presentation. He said, over the din and in his charmingly accented English, something approximating the following: “Rogers told me he never wanted to start an orthodoxy, but some people don’t understand that. There are different kinds of people, so we need different kinds of therapy. I enjoyed your presentation because it brings a different approach.”

After the most of the other had left, we stayed for a bit and talked with some of the postgraduate students from the Alberto’s Rome training centre (he has 2 others in Italy). One of them told us, that she had heard me talk when I came to Italy before 2 years ago but found my presentation too technical, so she had planned to skip my talk. However, as she passed by the room, she discovered that I was presenting one of my own cases, so she stayed, and found it very interesting. I said, “Great, I like to surprise people!”

We walked back to the hotel. The Naples group was standing around outside the hotel, smoking. (Italy has recently banned smoking in public buildings, with the result that, like Scotland, one has to brave a gauntlet of second-hand smoke in order to enter most public buildings and restaurants.) They greeted us enthusiastically. When we arrived two days ago, only a couple people at the conference knew or recognized us, now we were “almost famous” (to quote a movie title). We used the computer in the hotel lobby to check our bank accounts, which appeared to be unmolested, and that was the end of our belated, odd and oddly satisfying, Roman Thanksgiving.

Presenting to the Italian Person-Centered Association

Entry for 25 November 2006:

This was the 7th Congress of IACP, the Associazione Europea della Psicoterapia Centrata sul Cliente e dell’Approccio Centrato sulla Persona “Carl Rogers”. I had presented the Person-Centred/Experiential therapy meta-analysis and a general call for research two years ago at another conference in Rome organized by Alberto Zucconi, so this time, I wanted to do something different. I was also concerned about the slow progress on the Italian end of the International Project on the Effectiveness of Psychotherapy and Psychotherapy Training (IPEPPT) that Alberto and I have been trying to organize for the past 2 1/2 years. Therefore, I decided that I should lead by example and present the HSCED study of client PE-111 (“George”). I had presented a version of this to the Strathclyde Monday Part-time diploma course a couple of weeks ago, and it had worked fairly well, so I was hopeful. I knew the presentation was too complicated for this audience, so I dropped big sections of it.

However, what I had not counted on was the scheduling of a memorial session for Antonio Ferrari, a well-loved member of the Rome Institute training staff who died of stomach cancer a couple of months ago. This session was directly before my 10 am Saturday morning session. When we arrived 15 min before my talk to meet with Gianni to sort out the equipment, we found the room overflowing with crying people in the midst of a collective act of grief.

There was nothing for it but to wait for the process to unfold, which took another hour, including break. It turned out that it was going to be very difficult get sound to go with the two video segments, which were really the heart of my presentation. Fortunately, I had just finished transcribing the segments, so I was prepared to work from the transcripts. However, Gianni refused to accept the technical limitations and vowed to continue to try to solve the problem.

After Alberto had stalled as long as he could, I began the presentation, with Alberto doing sequential translation. (My original translator had resigned when they saw my unedited Powerpoint slides, complaining that the talk was too technical.) Alberto and I were about halfway through the first segment, working off the transcript, when Gianni rushed in; he had slipped out and gone to a local shop to buy the needed cable for hooking up my laptop to the sound system. We finished the transcript, and the following material up the second video segment, then plugged the laptop into sound system.

In the midst of this chaotic process, it began to emerge that Alberto’s translation was taking 2 to 3 times longer than the original English-language version (I had planned for a 1 to 1 ratio of English to Italian). That meant that the presentation was taking much longer than I had anticipated and that I would have to jettison large parts of it. With all the build-up, the audience clearly wanted to hear and see the segment, so that was going to be pretty much the rest of my talk. At this point, many members of the audience said they wanted to hear the whole segment first, before hearing Alberto’s translation. This turned out to be a very good idea, because it allowed even the non-English-speakers in the audience to pay attention to the nonverbals and vocal quality. Then we turned the sound down and played the segment through again, with the transcript displayed next to it. (I had spent quite a bit of time setting this up beforehand, as a contingency plan. Sometimes planning does help!) This had the effect of forcing Alberto to translate quite a bit faster, achieving about a 2:1 ratio as he enacted the segment, grunting and hyperventilating convincingly as the client experienced first a panic episode in the session trauma memories, then accessed trauma memories related to his experience of his panic episodes. At the end, we all applauded Alberto for his performance. Then I took a few minutes to round out the presentation by presenting the outcome data.

In the end, I had presented less than half of the slides in my drastically cut-down presentation; Alberto had stolen the show with his Method Acting; the conference was now running an hour behind schedule… and I had a sense that the presentation had, in spite of all the tribulations, actually been a great success! At the same time, I felt exhausted and drained, even though Alberto had done most of the work. But this was what I had come to do, and it had not crashed and burned, so I felt relieved and thankful and it was over.

The Experience of Being Robbed on the Rome Subway

Entry for 24-26 November 2006:

We had walked around the center of Rome for several hours, seeing the usual tourist things: Spanish Steps, Trevi Fountain, Pantheon (our favorite!), Piazza Venetia, Colloseum, the Circus Maximus. We were tired but looking forward to dinner with Alberto and the Italian Person-Centered Association Board. Changing trains at Termini station, we were packed like sardines onto the train for Flaminio. I was using both arms to hang onto to overhead handhold, in order to brace myself in the crowd. As we came into Repubblica Station, I felt a strange sensation of lightness in my right front pocket, where I had put my wallet for safety; however I was so crowded into place that I was unable to move until the doors had opened and the pressure of people released. I immediately felt my pocket in order to reassure myself, but was startled to discover that my wallet was not in my pocket. I checked again, then checked my other pockets. I felt stunned, startled, confused, with a growing sense that I had been pick-pocketed. I looked at the people around me; everyone looked normal. I looked around on the floor next to me, in case my wallet had somehow fallen out of my pocket; there was nothing but shoes and floor. An older man had been standing in front of me, but wasn’t there anymore; could it have been him?, I wondered. At some point in this process, the doors had closed and the train had moved on to the next station. I wondered if I should yell out something, but I now felt embarrassed and humiliated for having let myself be to vulnerable, and I didn’t know what I should say. “Stop thief,” seemed like it would be too dramatic, and I felt I didn’t want to make a disturbance. I looked at the people on the train around me, realizing that although the thief might very well have left already, they could still be right there, hidden in the normality of those around me… or not. I felt paralyzed.

It’s hard to tell how much time had passed by this time, or, now 2 days later as I write about it, even what the exact order of events was. But it was only after all this had gone through my mind and I had looked around twice that I said in a low voice to Diane, who was watching me with concern, “I think my wallet is missing. I think I’ve been robbed.” She looked at me, as if to say, “What are you going to do?” I shrugged my shoulders. A woman was looking at me with concern. I told her “My wallet has been stolen.” I heard the word “Rubato,” Italian for “robbed,” rippling away from me through the subway car. She looked concerned, but moved away from me, as if -- I felt -- I was some how infected. “What should we do?,” Diane asked. “There is nothing to do for now,” I said shrugging my shoulders again.

I felt shaken, embarrassed, and guilty that I had messed up our experience here, but also strangely light and vulnerable. However, I was already thinking about what we were going to do about it, once we got somewhere where we could do something. Although still upset, I was already beginning to be resigned to what had happened, and I was also beginning to reflect on the meaning of this experience: I realized that I/we would survive this, it wasn’t absolute catastrophe; I still had my passport. In fact, my wallet had contained only 30 euros and 15 gbp. And Diane was here, so I didn’t have to face dealing with it alone. We were a “we,” and we had resources available to us, including Diane’s purse and our friends at the conference.

We arrived at Flaminio. Diane thought I should find a policeman to report the theft to. We walked to the short distance to the Roma Nord rail station, where we tried to talk to a policeman, who told us he couldn’t speak English. We got on a train we thought was going to the Euclide station, where the hotel was. While we sat there for what seemed like an hour waiting for the train to leave (but was probably only about 20 min), we tried to figure out where we stood and what to do next, what our priorities were.

When we got back to the hotel, we set about canceling our credit cards, and figuring out what else had been in my missing wallet. We made a list, phoned the credit card companies, and by dinnertime had arranged for an emergency card to be couriered to the hotel the next day. We had a lovely meal at a traditional Italian restaurant near the hotel (about which see my next entry, because we went back there again the following night for the conference dinner). Then we took Alberto up on his very generous offer to accompany us to the local police station to fill out a crime report.

The police station was not far from the hotel; it was a slow night in this quiet northern suburb of Rome, so the policeman on duty was able to help us fill out the report, which Alberto handwrote at my dictation. The process took about 20 minutes; the policeman made 4 copies of the report, had me sign them, and handed me a copy to take with me for dealing with the various agencies who were not going to be happy that I had lost their cards and now wanted new ones.

By now the next day, our no-frills emergency credit card has arrived. As we left this morning, Alberto presented me with a tie and a new wallet. Straightening out the rest of the mess will have to wait for several later days.

* * *

Although I have had articles of clothing stolen in the past, I had never had my pocket picked. The strangeness of the experience fascinates me: The initial feeling of lightness in my pocket, my shock and paralysis, the feeling of lightness, vulnerability but also a kind of freedom. The paralysis makes perfect sense as the natural result of surprise and embarrassment, two emotions that motivate stilling oneself or even shrinking back. Why didn’t I feel anger, which would have motivated assertive or even aggressive action? There was no immediate threat to my person, no one menacing, instead only confusion and a community of strangers. The lightness feels something like: “It’s only a wallet; it’s only stuff; it isn’t the essence of who I am that was stolen.” Now it had happened, and there was nothing but the freedom to live into it.

In retrospect, this was an experience that I had feared and prepared for since I first came to Rome with my Grandmother in 1963. In my black hat, tall, I clearly had attracted the thief’s attention as a foreigner and possible target, but there had clearly been a strong element of chance to the event. Still, when we took the same train the next day, I guarded my pocket more carefully, aware that my previous strategy of avoiding theft had not worked and that I needed to be more careful.