Entry for 26 December 2007:
When my youngest son, Kenneth, was about 6 years old, he brought a baby pine tree, 6 to 8 inches tall including roots, home from school one day in a plastic bag as an Earth Day project. What do you do with a grade school project tree? I couldn’t bear to let it rot in the plastic bag and throw it away, so I planted it in an empty planter next to the back driveway. For years it grew there, among the marigolds and impatiens that we planted each summer, surviving the harsh winters and the demise of multiple planters.
On arriving home in Toledo last week, Diane and I both spotted Kenneth’s tree – now more than four feet tall -- sitting on raised cement porch area behind the house next to the driveway. Independently, we each hatched the plan to recruit it for service as this year’s Christmas tree. Diane picked the dead needles off it and washed the grime off its big plastic planter, and we carefully carried it into the house, setting it up by the front window. There it made a dandy Christmas tree, especially after the kids decorated it with a modest string of lights and a few well-chosen ornaments. We don’t know how it will deal with being shifted between drastically different micro-climates (from cold and snowy in the teens and twenties – minus 8 to minus 5 in Celsius – to the dry indoors heat). But for this year at least, we are honoured to have Kenneth’s tree as a guest in our house, hosting the presents that gathered around it, a gift from the past.
Friday, December 28, 2007
Thursday, December 27, 2007
Return to Toledo; Fixing the Landline
Entry for 19-25 December 2007:
Northern Ohio and southern Michigan got 6 to 10 inches the day we flew back from Glasgow. We kept expecting to be told that our Amsterdam-Detroit flight had been cancelled on account of snow, but it didn’t happen. We chased the sun from Amsterdam to Detroit, and were delighted that the sky was still light when we touched down in Detroit about 6 in the evening. Two more hours of daylight (8 am to 5 pm) here than in Scotland right now! What a difference! We felt better immediately.
The snow had stopped and the sky was clear, but there was about 10 inches of new snow on the ground, and Linda was too wiped out from shovelling driveways most of the day to come and get us. Inconvenient, but we were so grateful just to have made it this far, that it was as if a bubble of grace surrounded us, insulating from a sense of hassle or panic. After considering our options (hotel? rental car? taxi?), we sprang for a Checker Taxi Company taxi ride from Detroit Metro to Toledo, for US$110 plus tip. Under previous circumstances we had balked at the expense, but the rental car was more expensive and less convenient, the road conditions uncertain at best, and the jet lag rode heavily on our brains. Given all that, we were very pleased to pay the middle-aged African-American woman to take us home. Her Detroit accent washed over us pleasantly as she chattered at us in response to our questions about her work, her cars, and her life, grace upon grace as we rode south in her black Lincoln Continental, a tank over frozen waters.
Toledo had had about 6 inches, but Linda had shovelled us out (thanks, Linda!), so the driveway was passable. There is now a grand piano in our living room, which is interesting, more bookshelves, and new curtains to cut winter heat loss, but beyond that little has changed since August. Linda is on a low carb diet, but we had been doing preventive eating all day and weren’t that hungry. What we were was extremely tired… so we crashed.
The next morning a host of tasks fell on us, but principal among them was the fact that (a) the upstairs shower handle had come off and broken and (b) our telephone landline was dead. Also, my malpractice insurance had been allowed to expire, as had Diane’s nursing license; our accountant had gone to Florida again just when we needed her; and my life insurance company was trying to cut our benefits drastically again. However, there is nothing like a good engineering crisis to demand one’s total attention.
But first we had to pick Kenneth up from Cleveland, where he had just finished his Greek final and was anxiously waiting from us to come pick him up. We’d warned him that we might be delayed in picking him up, but still he groaned when he realized that we were going to be 3 hours late (he hates being late…). Still, he was very glad to see us again, and chattered at us most of the way back to Toledo, narrating us through his latest computer game music CD and explaining the difference between square and triangular wave forms in early game music technology.
After trouble-shooting and testing our landline, I determined that the problem was ours rather than the phone company’s. However, the internal phone wiring, emanating from a pair of terminals among the roof beams and joists of the laundry room in the basement, was a chaotic spaghetti of different colored wires and phone cables snaking in from all directions and ending in tangle of green, red, yellow and brown wires, some connected to one of the terminals, others not. At first this made no sense at all, but over the course of the next days, I gradually learned to read the pattern. Close inspection showed that there was a problem with the phone cable leading from the Network Interface Device (NID) on the outside of the house through two layers of siding and wall to one of the two internal terminals: The insulating plastic or rubber of this cable, which appeared to be at least 50 years old, was cracked and split near where it disappeared into a hole in the outer layer of aluminium siding.
The first hardware store we tried had gone out of business sometime in the past 3 years, so, with some dread, we drove down to the dreaded Home Depot (known among the family as Home Despot because it has driven almost all of the small hardware stores in town out of business). Tuesday afternoon turned out to be a brilliant time for a hardware chore: Instead of being ignored and left to wander hopelessly among the vast aisles of the place, we were flocked with helpers, often travelling in pairs, who passed us from one to another, so that in 10 minutes we had solutions to both of our engineering problems.
There then ensued a long process of figuring out (a) which of the 8 wires in the new phone cable attached to the which terminal (answer: white with blue stripes = green; blue with white stripes = red); (b) how to get through the two layers of siding and wall, where it turned out that the newer aluminum siding had been put up around the old phone cable such that the two holes didn’t line up at all (answer: drill a new hole through the aluminum siding to match the other hole, while Kenneth used the new wire to tap repeatedly against the outer siding until his arm developed cramps; and (c) what order to do this all in (answer: strip the inside end of the new phone line first and attach it to the terminal inside, because it’s harder to work up in the ceiling of the laundry room than to stand around outside – assuming that the weather wasn’t too horrible)
After attaching the new cable to the terminal, while making sure that the old wires were still attached, I went outside, stuck the end through the rubber grommet piece at the bottom of the network interface device, stripped the outer and inner coverings off of it, and attached the appropriate white and blue wires to the green and red terminals. I then tested the different internal phone lines, and discovered that the most commonly used phone jack, in the dining room, didn’t work.
I thought I’d gotten all the wires attached, but apparently I’d missed a pair, which had somehow come loose in the process. I had ignored this pair because it was the wrong color (orange and orange with white stripes), and because the wire went off in the opposite direction from the dining room. Unfortunately, I couldn’t find any information about this type of wire, and so I didn’t know what polarity to use. I had Diane pick up the phone in the dining room and listen while I tested this pair of wires. This whole process involved tracking in and out of the house about 20 times, because whenever you work on the wiring you have to unplug the household wires from the phone company’s line, which carried 50 volts and can give a nasty shock.
Fortunately, the dining room phone circuit worked when I touched rogue pair of wires to the terminal. Success! I attached these additional wires firmly to the terminal, along with four pairs of green and red wires, feeling very proud of myself, and went off to visit Brendan and Mayumi in Cleveland for a couple of days.
Unfortunately, when we got back home again a couple of days later, the landline was dead again. It was extremely windy that day, and I wondered if the wind had done something to the new wire I’d run. No luck. After more testing and research, I concluded that the problem wasn’t the new wire I’d run, but instead was due to an internal short somewhere in the house phone circuits. That is, two wires were touching, closing the circuit and telling the phone company that a phone was off the hook, yielding a busy signal when called from the outside and a dead line from the inside. At this point, I didn’t feel up to tackling the internal phone wiring; however, AT&T’s service website and service phone line were both down. We resigned ourselves to sticking with our ancient cell phone for the immediate future.
After mulling it over for a day, I decided after all to tackle the internal wiring. With Brendan helping and my handy multi-meter, I first tested the new wire coming into the house and found it carrying 50 watts. I then disconnected the dodgy dining room line that I had had trouble with before: Viola’! Dial tone! The dining room line has a short in it (probably in the jack) and was taking down the internal landline whole system. I secured the other 5 pairs of wires (4 internal; 1 external) to the terminal, and taped over the dining room phone jack. Maybe I’ll try to fix that on my next trip back to Toledo, but for now this is good enough.
Northern Ohio and southern Michigan got 6 to 10 inches the day we flew back from Glasgow. We kept expecting to be told that our Amsterdam-Detroit flight had been cancelled on account of snow, but it didn’t happen. We chased the sun from Amsterdam to Detroit, and were delighted that the sky was still light when we touched down in Detroit about 6 in the evening. Two more hours of daylight (8 am to 5 pm) here than in Scotland right now! What a difference! We felt better immediately.
The snow had stopped and the sky was clear, but there was about 10 inches of new snow on the ground, and Linda was too wiped out from shovelling driveways most of the day to come and get us. Inconvenient, but we were so grateful just to have made it this far, that it was as if a bubble of grace surrounded us, insulating from a sense of hassle or panic. After considering our options (hotel? rental car? taxi?), we sprang for a Checker Taxi Company taxi ride from Detroit Metro to Toledo, for US$110 plus tip. Under previous circumstances we had balked at the expense, but the rental car was more expensive and less convenient, the road conditions uncertain at best, and the jet lag rode heavily on our brains. Given all that, we were very pleased to pay the middle-aged African-American woman to take us home. Her Detroit accent washed over us pleasantly as she chattered at us in response to our questions about her work, her cars, and her life, grace upon grace as we rode south in her black Lincoln Continental, a tank over frozen waters.
Toledo had had about 6 inches, but Linda had shovelled us out (thanks, Linda!), so the driveway was passable. There is now a grand piano in our living room, which is interesting, more bookshelves, and new curtains to cut winter heat loss, but beyond that little has changed since August. Linda is on a low carb diet, but we had been doing preventive eating all day and weren’t that hungry. What we were was extremely tired… so we crashed.
The next morning a host of tasks fell on us, but principal among them was the fact that (a) the upstairs shower handle had come off and broken and (b) our telephone landline was dead. Also, my malpractice insurance had been allowed to expire, as had Diane’s nursing license; our accountant had gone to Florida again just when we needed her; and my life insurance company was trying to cut our benefits drastically again. However, there is nothing like a good engineering crisis to demand one’s total attention.
But first we had to pick Kenneth up from Cleveland, where he had just finished his Greek final and was anxiously waiting from us to come pick him up. We’d warned him that we might be delayed in picking him up, but still he groaned when he realized that we were going to be 3 hours late (he hates being late…). Still, he was very glad to see us again, and chattered at us most of the way back to Toledo, narrating us through his latest computer game music CD and explaining the difference between square and triangular wave forms in early game music technology.
After trouble-shooting and testing our landline, I determined that the problem was ours rather than the phone company’s. However, the internal phone wiring, emanating from a pair of terminals among the roof beams and joists of the laundry room in the basement, was a chaotic spaghetti of different colored wires and phone cables snaking in from all directions and ending in tangle of green, red, yellow and brown wires, some connected to one of the terminals, others not. At first this made no sense at all, but over the course of the next days, I gradually learned to read the pattern. Close inspection showed that there was a problem with the phone cable leading from the Network Interface Device (NID) on the outside of the house through two layers of siding and wall to one of the two internal terminals: The insulating plastic or rubber of this cable, which appeared to be at least 50 years old, was cracked and split near where it disappeared into a hole in the outer layer of aluminium siding.
The first hardware store we tried had gone out of business sometime in the past 3 years, so, with some dread, we drove down to the dreaded Home Depot (known among the family as Home Despot because it has driven almost all of the small hardware stores in town out of business). Tuesday afternoon turned out to be a brilliant time for a hardware chore: Instead of being ignored and left to wander hopelessly among the vast aisles of the place, we were flocked with helpers, often travelling in pairs, who passed us from one to another, so that in 10 minutes we had solutions to both of our engineering problems.
There then ensued a long process of figuring out (a) which of the 8 wires in the new phone cable attached to the which terminal (answer: white with blue stripes = green; blue with white stripes = red); (b) how to get through the two layers of siding and wall, where it turned out that the newer aluminum siding had been put up around the old phone cable such that the two holes didn’t line up at all (answer: drill a new hole through the aluminum siding to match the other hole, while Kenneth used the new wire to tap repeatedly against the outer siding until his arm developed cramps; and (c) what order to do this all in (answer: strip the inside end of the new phone line first and attach it to the terminal inside, because it’s harder to work up in the ceiling of the laundry room than to stand around outside – assuming that the weather wasn’t too horrible)
After attaching the new cable to the terminal, while making sure that the old wires were still attached, I went outside, stuck the end through the rubber grommet piece at the bottom of the network interface device, stripped the outer and inner coverings off of it, and attached the appropriate white and blue wires to the green and red terminals. I then tested the different internal phone lines, and discovered that the most commonly used phone jack, in the dining room, didn’t work.
I thought I’d gotten all the wires attached, but apparently I’d missed a pair, which had somehow come loose in the process. I had ignored this pair because it was the wrong color (orange and orange with white stripes), and because the wire went off in the opposite direction from the dining room. Unfortunately, I couldn’t find any information about this type of wire, and so I didn’t know what polarity to use. I had Diane pick up the phone in the dining room and listen while I tested this pair of wires. This whole process involved tracking in and out of the house about 20 times, because whenever you work on the wiring you have to unplug the household wires from the phone company’s line, which carried 50 volts and can give a nasty shock.
Fortunately, the dining room phone circuit worked when I touched rogue pair of wires to the terminal. Success! I attached these additional wires firmly to the terminal, along with four pairs of green and red wires, feeling very proud of myself, and went off to visit Brendan and Mayumi in Cleveland for a couple of days.
Unfortunately, when we got back home again a couple of days later, the landline was dead again. It was extremely windy that day, and I wondered if the wind had done something to the new wire I’d run. No luck. After more testing and research, I concluded that the problem wasn’t the new wire I’d run, but instead was due to an internal short somewhere in the house phone circuits. That is, two wires were touching, closing the circuit and telling the phone company that a phone was off the hook, yielding a busy signal when called from the outside and a dead line from the inside. At this point, I didn’t feel up to tackling the internal phone wiring; however, AT&T’s service website and service phone line were both down. We resigned ourselves to sticking with our ancient cell phone for the immediate future.
After mulling it over for a day, I decided after all to tackle the internal wiring. With Brendan helping and my handy multi-meter, I first tested the new wire coming into the house and found it carrying 50 watts. I then disconnected the dodgy dining room line that I had had trouble with before: Viola’! Dial tone! The dining room line has a short in it (probably in the jack) and was taking down the internal landline whole system. I secured the other 5 pairs of wires (4 internal; 1 external) to the terminal, and taped over the dining room phone jack. Maybe I’ll try to fix that on my next trip back to Toledo, but for now this is good enough.
Tuesday, December 18, 2007
Research Clinic Progress & Advanced Research Training
Entry for 16 December 2007:
It has been a busy several weeks. Now, we’re on our way back to the US for three weeks holiday and to see our families, and I certainly feel that I’ve earned a break. (Actually, the general consensus of friends, family & colleagues is that I’m working too hard and need to cut back on something.)
Research Clinic. The research clinic is now operational, more than 20 potential clients have contacted us, and this past week the first three clients began therapy, two in the social anxiety and one in the practice-based research protocol (two others have been assigned to therapists and are awaiting first sessions). Three student counsellors have joined us so far and will be seeing clients in the new year as part of their training experience. We have been designing systems for tracking clients, scheduling rooms, communicating with security about building opening times, and supervising both research and therapy. I have been able to draw on my long experience running my research clinic at the University of Toledo, but there is less infrastructure in place here, and so we have had to design new processes beyond what I am familiar with. The research clinic’s demands are immediate and pressing, and thus need to be prioritized over most other demands, such as writing. Diane has been helping with phone screenings and intake/diagnostic interviewing, which has been a great help to me and Brian, but even so we have been run ragged. I think we are hoping that two or three weeks’ breathing space will enable us to finish sorting out the basic arrangements and to get caught up on our sleep. However, what is already becoming clear is how having a working research clinic provides a source of energy and excitement, and a focus for further developments.
Advanced Research Training in Qualitative Methods. In addition to the conference presentations of November (discussed in previous entries), I’ve also had a pretty full complement of teaching activities, including a new 2-day intensive Advanced Research Training in qualitative research last weekend, partly co-taught with John McLeod. There were 10 participants, including all of our current PhD students and some others. Almost all had previous experience doing qualitative research, which enabled us to start at a fairly high level. This was a new and refreshing experience, and we had many productive and useful discussions. In addition to the usual lectures on the methods and demonstrations of analytic practices (such as preparing the text for analysis), John and I developed a format of asking participants to take a couple minutes to write down “the questions that you will be sorry you didn’t ask after we are done”. The participants’ questions were excellent and served to generate productive discussions of practical topics such as making time in one’s life for working on research and how to support wider scientific acceptance of qualitative research.
A good esprit de corps developed among the participants, who collected each others’ email addresses and have now set up an email list for exchanging information, which John has been using to distribute particularly nice examples of qualitative research as a follow up on the workshop. And so we have begun to develop a third, advanced/doctoral, level in the system we are setting up for research training, to complement the diploma-level practice-based research training and the masters-level intermediate research training. Each of these groups of students has particular needs and so research training needs to be carefully targeted in content and level of material provided.
This experience in turn is helping us redesign the taught input for the MSc course for the next intake of students in September. For example, we are asking the PhD research students if they would like to help out with the series of intensive research days for we plan to offer next autumn, and also if they’d like to help supervision the MSc students, in a kind of pyramid model. This makes all kinds of sense, because it also helps prepare the PhD students for academic positions.
And the research clinic in turn opens up new possibilities for the research students to carry out their research, if we go to the trouble to make sure it all works together!
It has been a busy several weeks. Now, we’re on our way back to the US for three weeks holiday and to see our families, and I certainly feel that I’ve earned a break. (Actually, the general consensus of friends, family & colleagues is that I’m working too hard and need to cut back on something.)
Research Clinic. The research clinic is now operational, more than 20 potential clients have contacted us, and this past week the first three clients began therapy, two in the social anxiety and one in the practice-based research protocol (two others have been assigned to therapists and are awaiting first sessions). Three student counsellors have joined us so far and will be seeing clients in the new year as part of their training experience. We have been designing systems for tracking clients, scheduling rooms, communicating with security about building opening times, and supervising both research and therapy. I have been able to draw on my long experience running my research clinic at the University of Toledo, but there is less infrastructure in place here, and so we have had to design new processes beyond what I am familiar with. The research clinic’s demands are immediate and pressing, and thus need to be prioritized over most other demands, such as writing. Diane has been helping with phone screenings and intake/diagnostic interviewing, which has been a great help to me and Brian, but even so we have been run ragged. I think we are hoping that two or three weeks’ breathing space will enable us to finish sorting out the basic arrangements and to get caught up on our sleep. However, what is already becoming clear is how having a working research clinic provides a source of energy and excitement, and a focus for further developments.
Advanced Research Training in Qualitative Methods. In addition to the conference presentations of November (discussed in previous entries), I’ve also had a pretty full complement of teaching activities, including a new 2-day intensive Advanced Research Training in qualitative research last weekend, partly co-taught with John McLeod. There were 10 participants, including all of our current PhD students and some others. Almost all had previous experience doing qualitative research, which enabled us to start at a fairly high level. This was a new and refreshing experience, and we had many productive and useful discussions. In addition to the usual lectures on the methods and demonstrations of analytic practices (such as preparing the text for analysis), John and I developed a format of asking participants to take a couple minutes to write down “the questions that you will be sorry you didn’t ask after we are done”. The participants’ questions were excellent and served to generate productive discussions of practical topics such as making time in one’s life for working on research and how to support wider scientific acceptance of qualitative research.
A good esprit de corps developed among the participants, who collected each others’ email addresses and have now set up an email list for exchanging information, which John has been using to distribute particularly nice examples of qualitative research as a follow up on the workshop. And so we have begun to develop a third, advanced/doctoral, level in the system we are setting up for research training, to complement the diploma-level practice-based research training and the masters-level intermediate research training. Each of these groups of students has particular needs and so research training needs to be carefully targeted in content and level of material provided.
This experience in turn is helping us redesign the taught input for the MSc course for the next intake of students in September. For example, we are asking the PhD research students if they would like to help out with the series of intensive research days for we plan to offer next autumn, and also if they’d like to help supervision the MSc students, in a kind of pyramid model. This makes all kinds of sense, because it also helps prepare the PhD students for academic positions.
And the research clinic in turn opens up new possibilities for the research students to carry out their research, if we go to the trouble to make sure it all works together!
Tuesday, December 11, 2007
Trip to London and IAPT Conference
Entries for 1 & 11 December, 2007
Last March at UK SPR in Ravenscar, I met Jeremy Clark, a London psychoanalyst who was organizing a conference to address the Improving Access to Psychological Therapies (IAPT) initiative. His aim was and is to broaden the whole thing, in order to keep it from being totally hijacked by powerful CBT forces. We talked for a while, and I floated the possibility of my presenting the results of the person-centred/experiential meta-analysis, possibly the new updated version. In due course I sent him a copy of Elliott et al. (2004) and he invited me to take part.
So it was that, after teaching until 9pm on the last Wednesday of November, I found myself catching the Thursday 5.55am London train from Glasgow Central, in order to give my presentation on Friday. In the meantime, others had scheduled meetings around the IAPT Conference:
First, Sue Wheeler and Nancy Rowland had organized another meeting of the steering group for the ESRC-funded Researcher Development Initiative grant, which John McLeod and I are on. John couldn’t make it this time, so for my sins, I got myself volunteered to pull together an outline for a 5-day summer school on teaching introductory counselling research methods, plus an article for Counseling and Psychotherapy Research on the experiential model of research training. Both the summer school program and the article are to build on my 29 October blog entry from the last RDI meeting (“If I Ran the Zoo: A Modest Proposal for Training the Trainers”), which everyone involved with the project now appears to have read! I must confess that I feel somewhat intimidated by others’ support for this fairly radical approach. I’m not that used to groups of people going with my more radical ideas, so I certainly hope that my analysis of the issues in teaching counselling students about research and the likely useful strategies is correct. I wouldn’t want to lead all of us astray!
Second, Chris Evans and Tom Schroeder organized a meeting of the UK SPR Steering Committee over dinner at an Indian restaurant near Covent Garden. So I went from a long afternoon with my BACP friends to a long evening with my UK-SPR friends, which made for an extremely long day. The steering group has been struggling to get tasks done, and Chris was bemoaning this, so I suggested that part of the problem might be that we don’t really know each other that well and that we might very well spend some time “team building” by talking about ourselves, which we did to good effect. Apparently, my person-centred colleagues are wearing off on me! At any rate, we got through several important items and decided that it would be good idea to try to emphasize the positive aspects of the UK Regional chapter to the larger SPR executive committee and to our members. I was very grateful when I finally returned to my somewhat seedy hotel near King’s Cross train station and crashed.
Friday morning I woke up with the realization that my talk, scheduled for later that afternoon needed more work. After I grabbed breakfast, I made most of these changes and dashed off to find the meeting site, at Savoy Place near the Thames. This turned out to be the Institute for Electrical Engineering, and sported a statue of Dave Faraday outside and depictions of various important scientific figures around the inside of the building, including, I noted with pleasure, Lord Kelvin, a native Scot from the Glasgow area.
* * *
Coming back to this abandoned entry 10 days later (and after 25 hours of teaching last week), what stands out in my mind the most is the way in which the IAPT conference provided a total immersion experience in the multiple intercutting agendas of the major players in the IAPT debate and their impact on each other:
It is equally obvious that the group dynamic by which the CBT folks were made to feel unwelcome and insulted at their own party is unhealthy and dangerous. In my opinion, this level of mistreatment and villification will only make them mean-spirited and more likely to feel justified in sticking it to everyone else. It is becoming very clear to me that dialogue among person-centred/experiential, psychodynamic and CBT folks is essential to our all moving forward. I have to confess to having engaged in a fair amount of CBT-bashing in the past, but I’m thinking that this is becoming increasingly counter-productive.
Last March at UK SPR in Ravenscar, I met Jeremy Clark, a London psychoanalyst who was organizing a conference to address the Improving Access to Psychological Therapies (IAPT) initiative. His aim was and is to broaden the whole thing, in order to keep it from being totally hijacked by powerful CBT forces. We talked for a while, and I floated the possibility of my presenting the results of the person-centred/experiential meta-analysis, possibly the new updated version. In due course I sent him a copy of Elliott et al. (2004) and he invited me to take part.
So it was that, after teaching until 9pm on the last Wednesday of November, I found myself catching the Thursday 5.55am London train from Glasgow Central, in order to give my presentation on Friday. In the meantime, others had scheduled meetings around the IAPT Conference:
First, Sue Wheeler and Nancy Rowland had organized another meeting of the steering group for the ESRC-funded Researcher Development Initiative grant, which John McLeod and I are on. John couldn’t make it this time, so for my sins, I got myself volunteered to pull together an outline for a 5-day summer school on teaching introductory counselling research methods, plus an article for Counseling and Psychotherapy Research on the experiential model of research training. Both the summer school program and the article are to build on my 29 October blog entry from the last RDI meeting (“If I Ran the Zoo: A Modest Proposal for Training the Trainers”), which everyone involved with the project now appears to have read! I must confess that I feel somewhat intimidated by others’ support for this fairly radical approach. I’m not that used to groups of people going with my more radical ideas, so I certainly hope that my analysis of the issues in teaching counselling students about research and the likely useful strategies is correct. I wouldn’t want to lead all of us astray!
Second, Chris Evans and Tom Schroeder organized a meeting of the UK SPR Steering Committee over dinner at an Indian restaurant near Covent Garden. So I went from a long afternoon with my BACP friends to a long evening with my UK-SPR friends, which made for an extremely long day. The steering group has been struggling to get tasks done, and Chris was bemoaning this, so I suggested that part of the problem might be that we don’t really know each other that well and that we might very well spend some time “team building” by talking about ourselves, which we did to good effect. Apparently, my person-centred colleagues are wearing off on me! At any rate, we got through several important items and decided that it would be good idea to try to emphasize the positive aspects of the UK Regional chapter to the larger SPR executive committee and to our members. I was very grateful when I finally returned to my somewhat seedy hotel near King’s Cross train station and crashed.
Friday morning I woke up with the realization that my talk, scheduled for later that afternoon needed more work. After I grabbed breakfast, I made most of these changes and dashed off to find the meeting site, at Savoy Place near the Thames. This turned out to be the Institute for Electrical Engineering, and sported a statue of Dave Faraday outside and depictions of various important scientific figures around the inside of the building, including, I noted with pleasure, Lord Kelvin, a native Scot from the Glasgow area.
* * *
Coming back to this abandoned entry 10 days later (and after 25 hours of teaching last week), what stands out in my mind the most is the way in which the IAPT conference provided a total immersion experience in the multiple intercutting agendas of the major players in the IAPT debate and their impact on each other:
-Government officials smugly laying out the New World Order of IAPT, but coming across as overbearing and annoying, particularly to the…In the end, it is obvious that the service users are a natural constituency for Person-Centred counselling and that we have totally missed the boat by not actively courting and collaborating with them.
-Mental health service users, invited but not entirely welcome guests at the party, who provided the major fire and interest with their anger and confrontation, annoying the government officials.
-Angry, defensive British psychoanalytic types (articulate but very little in the way of evidence).
-Entertaining American visitors (including my friend Jacques Barber), flown in for the occasion but somewhat above the fray and not entirely on the same planet as the rest of the crowd.
-Data mavens (like me) grinding through their research but not really part of the main action.
-The climatic Battle of the Professors (Michael Barkham & David Clarke, who managed to treat each other with considerable respect while still getting in lots of points for their side).
-Person-Centered and other counsellors (me, Mick, Sue Wheeler), scuttling about like early mammals in the late Jurassic, wondering who’s going to go extinct first.
-CBT folks silenced by the vocal criticisms of much of the crowd, hanging on the sidelines in what was supposed to be their moment of glory, visibly grinding their teeth.
It is equally obvious that the group dynamic by which the CBT folks were made to feel unwelcome and insulted at their own party is unhealthy and dangerous. In my opinion, this level of mistreatment and villification will only make them mean-spirited and more likely to feel justified in sticking it to everyone else. It is becoming very clear to me that dialogue among person-centred/experiential, psychodynamic and CBT folks is essential to our all moving forward. I have to confess to having engaged in a fair amount of CBT-bashing in the past, but I’m thinking that this is becoming increasingly counter-productive.
Tuesday, December 04, 2007
Client Change Review: A Therapist Self-Administered Version of the Change Interview (12/07)
Entry for 4 December 2007:
I developed this simplified version of the Client Change Interview in 2001, specifically for postgraduate students and other therapists or counsellors to use with their own clients, in situations in which it is not feasible to have a colleague or researchers interview one’s client. This revised version is presented here as a therapeutic task, and should be adapted to the particular counselling situation and client.
Task Marker: Client describes sense of significant progress; or reaches previously-agreed-upon review point (e.g., 8 or 10 sessions; end of therapy; end of semester).
General Approach. Facilitate an empathic exploration of the client’s experience of therapy/ counselling. For each topic listed, use open-ended questions plus empathic understanding responses to help the client elaborate on his/her experiences. Use the “anything else” probe (e.g., "Are there any other changes that you have noticed?") in a nondemanding way until the client runs out of things to say. This task should take 20-30 minutes.
Schedule of Questions:
1. What medications are you currently taking (can include dose, how long, last adjustment, herbal remedies)
2. What has therapy/counselling has been like so far? (How it has felt to be in therapy?)
3. What differences/changes (if any) have you noticed since therapy/counselling started? (e.g., doing, feeling, or thinking things differently from before; ideas about self or others; changes brought to your attention by others)
4. Has anything have changed for the worse since therapy/counselling started?
5. What do you feel has helped bring about these changes? What has helped make them possible?
6. Is there anything that hasn’t changed since therapy/counselling started, that you client wished had?
7. What has been most helpful about your therapy/counselling so far? (please give examples; may include general aspects, specific events).
8. Has there been anything about your therapy/counselling that might have been hindering, unhelpful, negative or disappointing? (may include general aspects, specific events).
9. Has there been anything about your therapy/counselling that has been difficult or painful but still OK or perhaps helpful?
10. Has anything been missing from therapy/counselling? Do you have any suggestions for improving it?
I developed this simplified version of the Client Change Interview in 2001, specifically for postgraduate students and other therapists or counsellors to use with their own clients, in situations in which it is not feasible to have a colleague or researchers interview one’s client. This revised version is presented here as a therapeutic task, and should be adapted to the particular counselling situation and client.
Task Marker: Client describes sense of significant progress; or reaches previously-agreed-upon review point (e.g., 8 or 10 sessions; end of therapy; end of semester).
General Approach. Facilitate an empathic exploration of the client’s experience of therapy/ counselling. For each topic listed, use open-ended questions plus empathic understanding responses to help the client elaborate on his/her experiences. Use the “anything else” probe (e.g., "Are there any other changes that you have noticed?") in a nondemanding way until the client runs out of things to say. This task should take 20-30 minutes.
Schedule of Questions:
1. What medications are you currently taking (can include dose, how long, last adjustment, herbal remedies)
2. What has therapy/counselling has been like so far? (How it has felt to be in therapy?)
3. What differences/changes (if any) have you noticed since therapy/counselling started? (e.g., doing, feeling, or thinking things differently from before; ideas about self or others; changes brought to your attention by others)
4. Has anything have changed for the worse since therapy/counselling started?
5. What do you feel has helped bring about these changes? What has helped make them possible?
6. Is there anything that hasn’t changed since therapy/counselling started, that you client wished had?
7. What has been most helpful about your therapy/counselling so far? (please give examples; may include general aspects, specific events).
8. Has there been anything about your therapy/counselling that might have been hindering, unhelpful, negative or disappointing? (may include general aspects, specific events).
9. Has there been anything about your therapy/counselling that has been difficult or painful but still OK or perhaps helpful?
10. Has anything been missing from therapy/counselling? Do you have any suggestions for improving it?
Sunday, December 02, 2007
Strathclyde Research Clinic Starts Seeing Clients
Entry for 29 November 2007:
After months of trying to figure out how to recruit clients for our two research protocols, Lorna and Brian finally contacted the Tom Allen Centre, a local voluntary (i.e., nonprofit) counselling agency. It turns out that, like many other similar agencies, they have a several-month waiting list. They agreed to provide clients on their waiting list with information about the Research Clinic.
As a result, beginning last week, clients have begun contacting us about both research protocols. Suddenly, we are in business! Since then, we have been receiving a steady stream of 1 or 2 new client contacts per day. Starting a new mental health agency, which is what we are, involves quite a bit of organizing, and there are many procedures and processes still being sorted. This is complicated by the fact that we are running two related but different research protocols. With lots of consultation from me, Brian and Diane have been trying out our phone pre-screening and intake screening procedures for each of the two protocols. They are getting the hang of the phone pre-screening, and are learning the ins and outs (sometimes the ups and downs) of the Personal Questionnaire (both protocols) and the SCID (social anxiety protocol). Next, they will take on the PDQ-4, the questionnaire-cum-structured interview we use to identify dysfunctional personality processes.
In the meantime, we have been interviewing and training 4 students for work in the Research Clinic as part of a counselling opportunity experience. Two students have already started and are being trained in the various procedures; we hope that the other two will begin soon, given that we are rapidly accumulating clients to be screened and counselled. We hope that they will be able to start seeing clients by next week. Diane and Brian are just ahead of them, sorting the procedures out and finding them clients.
There is a great deal of potential here: large numbers of clients to be seen, and counselors at various stages of training (including the folks in various stages of EFT training) interested in seeing clients in the two protocols. We are having to make lists of priorities for who gets to see clients, in what order.
There is much to do to get the Research Clinic really up and running: Details of supervision will have to be sorted. Filing systems, and methods of tracking (and not losing track of) clients need to be organized. Copies of the various research instruments are being made and assembled into packets. Next, rotas for phone pre-screenings and intakes need to be organized, and coverage of the research clinic at different hours and days, including evening hours, will have to be sorted. Space will quickly be at a premium, which means that overflow space and additional recording equipment will need to be acquired.
And those are just the immediate tasks: Beyond the logistics of seeing clients, we now need to set up regular staff meetings for managing all this; put in place practical procedures for implementing our data storage plans (e.g., making regular use of our secure video data storage system); and begin entering research data. The process of developing student research projects based in the research clinic has already begun.
Clearly, starting and managing a research clinic is a major commitment and a lot of work; but after the long wait to begin, it also a relief. Moreover, it is also energizing and exciting to return to the active interface between research and practice, to be able to touch into people’s lives, and to connect to the power of the relationship and the change processes that unfold in person-centred/experiential therapy.
After months of trying to figure out how to recruit clients for our two research protocols, Lorna and Brian finally contacted the Tom Allen Centre, a local voluntary (i.e., nonprofit) counselling agency. It turns out that, like many other similar agencies, they have a several-month waiting list. They agreed to provide clients on their waiting list with information about the Research Clinic.
As a result, beginning last week, clients have begun contacting us about both research protocols. Suddenly, we are in business! Since then, we have been receiving a steady stream of 1 or 2 new client contacts per day. Starting a new mental health agency, which is what we are, involves quite a bit of organizing, and there are many procedures and processes still being sorted. This is complicated by the fact that we are running two related but different research protocols. With lots of consultation from me, Brian and Diane have been trying out our phone pre-screening and intake screening procedures for each of the two protocols. They are getting the hang of the phone pre-screening, and are learning the ins and outs (sometimes the ups and downs) of the Personal Questionnaire (both protocols) and the SCID (social anxiety protocol). Next, they will take on the PDQ-4, the questionnaire-cum-structured interview we use to identify dysfunctional personality processes.
In the meantime, we have been interviewing and training 4 students for work in the Research Clinic as part of a counselling opportunity experience. Two students have already started and are being trained in the various procedures; we hope that the other two will begin soon, given that we are rapidly accumulating clients to be screened and counselled. We hope that they will be able to start seeing clients by next week. Diane and Brian are just ahead of them, sorting the procedures out and finding them clients.
There is a great deal of potential here: large numbers of clients to be seen, and counselors at various stages of training (including the folks in various stages of EFT training) interested in seeing clients in the two protocols. We are having to make lists of priorities for who gets to see clients, in what order.
There is much to do to get the Research Clinic really up and running: Details of supervision will have to be sorted. Filing systems, and methods of tracking (and not losing track of) clients need to be organized. Copies of the various research instruments are being made and assembled into packets. Next, rotas for phone pre-screenings and intakes need to be organized, and coverage of the research clinic at different hours and days, including evening hours, will have to be sorted. Space will quickly be at a premium, which means that overflow space and additional recording equipment will need to be acquired.
And those are just the immediate tasks: Beyond the logistics of seeing clients, we now need to set up regular staff meetings for managing all this; put in place practical procedures for implementing our data storage plans (e.g., making regular use of our secure video data storage system); and begin entering research data. The process of developing student research projects based in the research clinic has already begun.
Clearly, starting and managing a research clinic is a major commitment and a lot of work; but after the long wait to begin, it also a relief. Moreover, it is also energizing and exciting to return to the active interface between research and practice, to be able to touch into people’s lives, and to connect to the power of the relationship and the change processes that unfold in person-centred/experiential therapy.
Tuesday, November 27, 2007
COSCA Research Conference as Little Island
Entry for 26 November 2006:
After my arrival in Scotland last year, my first conference experience was at the annual research conference (or “dialogue”) of the Scottish Association for Counselling and Psychotherapy, known as COSCA. On that occasion, I was a keynote speaker, but I enjoyed it and felt it was a good opportunity to network. This year, I returned as an ordinary citizen, and found myself up to my ears in presentations, making for an intense but satisfying day.
The plenary sessions this year consisted of a careful selection of talks on key issues on counselling competencies and regulation, including presentations by Alex McMahon from NHS Education Scotland (about the status of the CBT-focused Improving Access to Psychological Therapies initiative here in Scotland), and Marc Lyall from Skills for Health, the people who are spearheading the writing of competencies for regulating counselling and psychotherapy, a process which is constantly threatening to write Person-Centred/Experiential (PCE) counselling/ psychotherapy out of the picture. Finally, Kay Kennedy, a lecturer at Glasgow Caledonian University, provided a realistic ground-level view of what regulation was likely to look like, by taking us through concrete examples of competency documents for Art Therapy and Occupation Health. It is important to be on top of these various political processes, so these updates were quite valuable for orienting us to the wide world of health care all around us.
As I said, I turned out to be quite busy at the conference, going into a version of my SPR overkill mode and presenting throughout the day:
First, the Social Anxiety team had decided to present our heuristic study of our own social anxiety experiences, so Gary Mooney summarized the results of the emotion scheme analysis, while Rebecca Black and Grahame Jack together presented analyses of the sources of social anxiety, together with peoples’ experiences of helpful and unhelpful processes in recovery from social anxiety. Time was short, but I thought they handled it well, and it was good to see this coming out of the work of the social anxiety team. Then, I briefly described the Social Anxiety study research protocol, and we concluded the session with a useful discussion.
After lunch, I presented, with help from Beth, the latest version of the Person-Centred/ Experiential (PCE) therapy meta-analysis, now featuring 36 new studies (up from 29 studies 10 days ago). We are continuing to refine this presentation, but the new studies are predominantly anti-PCE, resulting in a small but statistically significant overall unweighted comparative effect size of -.17 against PCE (and in favour of CBT). While this is totally consistent with the previous analyses of the large 2004 data set, it does make explaining the results more complicated. And, although I succeeded last week in successfully explaining standard deviations to the fulltime diploma course students, I did not totally succeed today. I really need to develop some cute slides explaining this concept in lay language! In end, though, I think we got our main points across that: (a) the facts are (generally) friendly and worth knowing about; and (b) practitioner research is important and can make a difference.
But that wasn’t all: Tracey and Beth were scheduled to present our very early work on the Therapeutic Relationship Scale, a new measure of Person-Centred concepts of relationship. Unfortunately, Tracey had to go out of town on urgent personal business, which left Beth and I to cover the session. We managed, however, first summarizing the measure development process and the rationale for the new instrument. We then handed out the draft version of the instrument for people to fill out and give us feedback on, which the audience set to with serious intent and which provided a nice change from the earlier, more didactic presentations.
After it was all over, Wendy Traynor, Pete Sanders, Mick and I hung around for awhile talking about research and book projects, before we walked Mick down to the train station. Then, Pete, Wendy and I went out for a delicious meal of Chinese vegetarian dishes, providing a welcome antidote for recent Thanksgiving-related carnivorous excesses. The full moon shone bright over Dunblane as I left them to catch my train back to Glasgow.
I like these little conferences, full of intense bursts of information and experience and leaving me with a deeper and richer sense of context. I end up feeling like the cat in my favorite picture book from my childhood, The Little Island, by Margaret Wise Brown: An island unto myself but still connected under the sea to the whole wide world.
After my arrival in Scotland last year, my first conference experience was at the annual research conference (or “dialogue”) of the Scottish Association for Counselling and Psychotherapy, known as COSCA. On that occasion, I was a keynote speaker, but I enjoyed it and felt it was a good opportunity to network. This year, I returned as an ordinary citizen, and found myself up to my ears in presentations, making for an intense but satisfying day.
The plenary sessions this year consisted of a careful selection of talks on key issues on counselling competencies and regulation, including presentations by Alex McMahon from NHS Education Scotland (about the status of the CBT-focused Improving Access to Psychological Therapies initiative here in Scotland), and Marc Lyall from Skills for Health, the people who are spearheading the writing of competencies for regulating counselling and psychotherapy, a process which is constantly threatening to write Person-Centred/Experiential (PCE) counselling/ psychotherapy out of the picture. Finally, Kay Kennedy, a lecturer at Glasgow Caledonian University, provided a realistic ground-level view of what regulation was likely to look like, by taking us through concrete examples of competency documents for Art Therapy and Occupation Health. It is important to be on top of these various political processes, so these updates were quite valuable for orienting us to the wide world of health care all around us.
As I said, I turned out to be quite busy at the conference, going into a version of my SPR overkill mode and presenting throughout the day:
First, the Social Anxiety team had decided to present our heuristic study of our own social anxiety experiences, so Gary Mooney summarized the results of the emotion scheme analysis, while Rebecca Black and Grahame Jack together presented analyses of the sources of social anxiety, together with peoples’ experiences of helpful and unhelpful processes in recovery from social anxiety. Time was short, but I thought they handled it well, and it was good to see this coming out of the work of the social anxiety team. Then, I briefly described the Social Anxiety study research protocol, and we concluded the session with a useful discussion.
After lunch, I presented, with help from Beth, the latest version of the Person-Centred/ Experiential (PCE) therapy meta-analysis, now featuring 36 new studies (up from 29 studies 10 days ago). We are continuing to refine this presentation, but the new studies are predominantly anti-PCE, resulting in a small but statistically significant overall unweighted comparative effect size of -.17 against PCE (and in favour of CBT). While this is totally consistent with the previous analyses of the large 2004 data set, it does make explaining the results more complicated. And, although I succeeded last week in successfully explaining standard deviations to the fulltime diploma course students, I did not totally succeed today. I really need to develop some cute slides explaining this concept in lay language! In end, though, I think we got our main points across that: (a) the facts are (generally) friendly and worth knowing about; and (b) practitioner research is important and can make a difference.
But that wasn’t all: Tracey and Beth were scheduled to present our very early work on the Therapeutic Relationship Scale, a new measure of Person-Centred concepts of relationship. Unfortunately, Tracey had to go out of town on urgent personal business, which left Beth and I to cover the session. We managed, however, first summarizing the measure development process and the rationale for the new instrument. We then handed out the draft version of the instrument for people to fill out and give us feedback on, which the audience set to with serious intent and which provided a nice change from the earlier, more didactic presentations.
After it was all over, Wendy Traynor, Pete Sanders, Mick and I hung around for awhile talking about research and book projects, before we walked Mick down to the train station. Then, Pete, Wendy and I went out for a delicious meal of Chinese vegetarian dishes, providing a welcome antidote for recent Thanksgiving-related carnivorous excesses. The full moon shone bright over Dunblane as I left them to catch my train back to Glasgow.
I like these little conferences, full of intense bursts of information and experience and leaving me with a deeper and richer sense of context. I end up feeling like the cat in my favorite picture book from my childhood, The Little Island, by Margaret Wise Brown: An island unto myself but still connected under the sea to the whole wide world.
Sunday, November 25, 2007
First Thanksgiving in Scotland
Entry for 24 November 2007:
It has been 4 years since I last celebrated Thanksgiving, one of my favorite American holidays: Last year we were in Rome (where my wallet was stolen) at this time, and the two previous years I spent Thanksgiving week in Belgium as part of my work at KU Leuven. This year we were home in Glasgow and decided it would be perfectly OK to celebrate American Thanksgiving on Saturday rather than the standard Thursday, in order to have adequate time to prepare the meal.
Thanksgiving is not the same without a group of people to celebrate it with, but this presented us with a dilemma: After our period of deprivation, we really needed a classic American Thanksgiving experience, which is meat-intensive. However, this ruled out being able to share the experience with our vegetarian friends. Fortunately, our friends Beth, Ana (her daughter), and Mikio eat meat and were up for the ritual.
Our local butcher can’t get turkeys in November (they are a Christmas thing here), so we settled for a fresh ham, which Diane could pick up on Saturday morning, and we eventually got a turkey breast from the Morrisons Supermarket (they did have whole frozen turkeys, but we were already committed to the ham).
We filled the menu out with green beans, green salad, a sweet potato dish (made with pineapple and finished in the microwave because there was no room in the oven), starters such as vegetable relish tray, with Beth supplying the rolls and Mikio providing the wine (Australian). The meal’s crowning glory was of course the pumpkin pie, all parts of which were handmade by Diane, including the filling, made from the fresh pumpkin that Mikio had given us in October (you can’t buy canned pumpkin here). We had to wait an hour, sipping tea and talking, for our appetite to return sufficiently to eat it.
We talked of many things over the course of the evening: what we are thankful for, our plans for the holidays, the upcoming COSCA conference (briefly), the history of the English language and language learning in general, and so on. It was late when they left, and of course there was the typical post-thanksgiving mess of leftovers and piles of dishes. Still, we were very happy with how it had all gone, thankful that we had been able to construct such an American holiday here in Scotland, grateful for good friends and the time. Having made this reconnection with our roots, we resolved that next time we would find a away to open the feast up to our vegetarian friends by adding a potluck element. Turkey and nutloaf!
It has been 4 years since I last celebrated Thanksgiving, one of my favorite American holidays: Last year we were in Rome (where my wallet was stolen) at this time, and the two previous years I spent Thanksgiving week in Belgium as part of my work at KU Leuven. This year we were home in Glasgow and decided it would be perfectly OK to celebrate American Thanksgiving on Saturday rather than the standard Thursday, in order to have adequate time to prepare the meal.
Thanksgiving is not the same without a group of people to celebrate it with, but this presented us with a dilemma: After our period of deprivation, we really needed a classic American Thanksgiving experience, which is meat-intensive. However, this ruled out being able to share the experience with our vegetarian friends. Fortunately, our friends Beth, Ana (her daughter), and Mikio eat meat and were up for the ritual.
Our local butcher can’t get turkeys in November (they are a Christmas thing here), so we settled for a fresh ham, which Diane could pick up on Saturday morning, and we eventually got a turkey breast from the Morrisons Supermarket (they did have whole frozen turkeys, but we were already committed to the ham).
We filled the menu out with green beans, green salad, a sweet potato dish (made with pineapple and finished in the microwave because there was no room in the oven), starters such as vegetable relish tray, with Beth supplying the rolls and Mikio providing the wine (Australian). The meal’s crowning glory was of course the pumpkin pie, all parts of which were handmade by Diane, including the filling, made from the fresh pumpkin that Mikio had given us in October (you can’t buy canned pumpkin here). We had to wait an hour, sipping tea and talking, for our appetite to return sufficiently to eat it.
We talked of many things over the course of the evening: what we are thankful for, our plans for the holidays, the upcoming COSCA conference (briefly), the history of the English language and language learning in general, and so on. It was late when they left, and of course there was the typical post-thanksgiving mess of leftovers and piles of dishes. Still, we were very happy with how it had all gone, thankful that we had been able to construct such an American holiday here in Scotland, grateful for good friends and the time. Having made this reconnection with our roots, we resolved that next time we would find a away to open the feast up to our vegetarian friends by adding a potluck element. Turkey and nutloaf!
Tuesday, November 20, 2007
Qualitative Research Secrets in Leicester
Entry for 17 November 2007
Sue Wheeler, at the University of Leicester, invited me down to do a day-long workshop on qualitative data analysis. This sounded interesting, and seemed like a good way to prepare the two-day qualitative research workshop John McLeod and I are doing next month, so I accepted. At dinner on Friday night with Sue, Julie Folkes-Skinner and others, I rashly promised Sue that I would present a list of “Qualitative Analysis secrets" at the day training on Saturday. I have had a feeling for some time that there is set of basic understandings about good practice in qualitative research that students in general and most folks in the UK don’t seem to share with North American qualitative researchers like David Rennie and I. The following is what I managed to come up with between dinner on Friday and breakfast on Saturday and then used as a kind of theme for the workshop, which turned out to be a great success. I’m sure that the list is incomplete, and that it could use sharpening, but at least it is a start:
I. Nine Truths about Qualitative Research in General:
A. On how hard it is:
1. Qualitative Research is harder (more work and more difficult) than quantitative research.
2. A qualitative research study is only as good as you are (as an interviewer and analyst).
3. If you don’t have good listening/empathic exploration skills, or if you aren’t logical and good with language, you should be doing quantitative research instead.
B. On Research Questions:
4. A clear definition of your topic and a clear statement of your research question is the most important requirement of good qualitative study. Everything follows from that!
5. Qualitative research is really good at answering open (exploratory) research questions. Conversely, if your main research question is closed (confirmatory), you should be doing a quantitative study instead.
C. Diversity and sameness:
6. Everyone does qualitative analysis differently. This is good.
7. The Brand Name Problem. Brand names for qualitative research are social fictions. Empirical phenomenology, Interpretative Phenomenological Analysis (IPA), Grounded Theory Analysis (GTA), and Consensual Qualitative Research are more similar than they are different. In fact, they refer to different but overlapping research traditions rather than different methods.
D. On Grounded Theory:
8. Grounded Theory Analysis. No one knows what Grounded Theory Analysis really is. Most is what is called GTA is based on Rennie, Elliott, Pigeon and others' construction of what they thought Glaser & Strauss (and Corbin) were talking about.
9. Consensual Qualitative Research (CQR) was not invented by Clara Hill; it is a form of GTA constructed by Elliott in the late 1980’s to deal with positivists (see #8).
II. Twelve Secrets about Qualitative Analysis:
A. On short cuts:
1. Selecting the bits you find interesting from a transcript is not qualitative analysis; it’s journalism. Qualitative analysis holds itself responsible for all meaning units. Journalism is a noble profession, but it's not qualitative research.
2. Computer software, such as NVIVO or MaxQDA) can be useful for housekeeping (i.e., counting categories, keeping things neat), but does not do qualitative data analysis; only people can do that.
3. The easiest, cheapest qualitative analysis software is Word, configured with two windows (one for your data, the other for your analysis). It won’t do your housekeeping, though; you’ll have to do that yourself.
B. On Domains vs. Categories:
4. Finding “categories” that correspond roughly to your interview schedule questions is not an analysis. If you stop there, you have wasted everyone’s time, including your informants’.
5. A category tells you something specific in answer to one of your research questions (=substantive categories).
6. But it can be very useful to divide your data up into broad, organizing domains (e.g., context, client contributions). These often but not always correspond to your research or interview topics. GTA call these formal categories, but they are not real categories, because they don’t tell us anything new about the topic.
C. On Categories:
7. Stomach coding: When you read your data, pay attention to how it feels in your gut (or wherever you feel things). When you make a new category or code a piece of data into a new category, make sure your stomach agrees with it. (Credit for this one to Gendlin and Rennie.)
8. The 37 category problem: Avoid the unnecessary multiplication of categories (Occam’s razor). Don’t let your categories multiply like rabbits until they overrun your analysis. (Also known as the flat, boring analysis problem.)
9. Analyses aren’t democracies (or large groups): Some categories are bigger/ more abstract/ broader/ more important than others. Stack them up like coat hanger trees or organizational charts, 3, 4, 5 or even 6 deep.
10. Constant comparison (GTA): Every time you come to a new meaning unit or add a new category, compare it to all your other meaning units/categories. (This can be tedious at first but becomes easy as your category system develops. Use your stomach to help with this!)
11. The rule of four: Whenever you get 4 or more categories at a particular level in your analysis, look to see how they relate to each other:
•They might go under an higher order category;
•They might form a sequence/narrative;
•They might go on some kind of dimension or continuum;
• … or maybe not.
But at least check!
12. Make a picture, flow chart or table that tells a story with your categories.
Sue Wheeler, at the University of Leicester, invited me down to do a day-long workshop on qualitative data analysis. This sounded interesting, and seemed like a good way to prepare the two-day qualitative research workshop John McLeod and I are doing next month, so I accepted. At dinner on Friday night with Sue, Julie Folkes-Skinner and others, I rashly promised Sue that I would present a list of “Qualitative Analysis secrets" at the day training on Saturday. I have had a feeling for some time that there is set of basic understandings about good practice in qualitative research that students in general and most folks in the UK don’t seem to share with North American qualitative researchers like David Rennie and I. The following is what I managed to come up with between dinner on Friday and breakfast on Saturday and then used as a kind of theme for the workshop, which turned out to be a great success. I’m sure that the list is incomplete, and that it could use sharpening, but at least it is a start:
I. Nine Truths about Qualitative Research in General:
A. On how hard it is:
1. Qualitative Research is harder (more work and more difficult) than quantitative research.
2. A qualitative research study is only as good as you are (as an interviewer and analyst).
3. If you don’t have good listening/empathic exploration skills, or if you aren’t logical and good with language, you should be doing quantitative research instead.
B. On Research Questions:
4. A clear definition of your topic and a clear statement of your research question is the most important requirement of good qualitative study. Everything follows from that!
5. Qualitative research is really good at answering open (exploratory) research questions. Conversely, if your main research question is closed (confirmatory), you should be doing a quantitative study instead.
C. Diversity and sameness:
6. Everyone does qualitative analysis differently. This is good.
7. The Brand Name Problem. Brand names for qualitative research are social fictions. Empirical phenomenology, Interpretative Phenomenological Analysis (IPA), Grounded Theory Analysis (GTA), and Consensual Qualitative Research are more similar than they are different. In fact, they refer to different but overlapping research traditions rather than different methods.
D. On Grounded Theory:
8. Grounded Theory Analysis. No one knows what Grounded Theory Analysis really is. Most is what is called GTA is based on Rennie, Elliott, Pigeon and others' construction of what they thought Glaser & Strauss (and Corbin) were talking about.
9. Consensual Qualitative Research (CQR) was not invented by Clara Hill; it is a form of GTA constructed by Elliott in the late 1980’s to deal with positivists (see #8).
II. Twelve Secrets about Qualitative Analysis:
A. On short cuts:
1. Selecting the bits you find interesting from a transcript is not qualitative analysis; it’s journalism. Qualitative analysis holds itself responsible for all meaning units. Journalism is a noble profession, but it's not qualitative research.
2. Computer software, such as NVIVO or MaxQDA) can be useful for housekeeping (i.e., counting categories, keeping things neat), but does not do qualitative data analysis; only people can do that.
3. The easiest, cheapest qualitative analysis software is Word, configured with two windows (one for your data, the other for your analysis). It won’t do your housekeeping, though; you’ll have to do that yourself.
B. On Domains vs. Categories:
4. Finding “categories” that correspond roughly to your interview schedule questions is not an analysis. If you stop there, you have wasted everyone’s time, including your informants’.
5. A category tells you something specific in answer to one of your research questions (=substantive categories).
6. But it can be very useful to divide your data up into broad, organizing domains (e.g., context, client contributions). These often but not always correspond to your research or interview topics. GTA call these formal categories, but they are not real categories, because they don’t tell us anything new about the topic.
C. On Categories:
7. Stomach coding: When you read your data, pay attention to how it feels in your gut (or wherever you feel things). When you make a new category or code a piece of data into a new category, make sure your stomach agrees with it. (Credit for this one to Gendlin and Rennie.)
8. The 37 category problem: Avoid the unnecessary multiplication of categories (Occam’s razor). Don’t let your categories multiply like rabbits until they overrun your analysis. (Also known as the flat, boring analysis problem.)
9. Analyses aren’t democracies (or large groups): Some categories are bigger/ more abstract/ broader/ more important than others. Stack them up like coat hanger trees or organizational charts, 3, 4, 5 or even 6 deep.
10. Constant comparison (GTA): Every time you come to a new meaning unit or add a new category, compare it to all your other meaning units/categories. (This can be tedious at first but becomes easy as your category system develops. Use your stomach to help with this!)
11. The rule of four: Whenever you get 4 or more categories at a particular level in your analysis, look to see how they relate to each other:
•They might go under an higher order category;
•They might form a sequence/narrative;
•They might go on some kind of dimension or continuum;
• … or maybe not.
But at least check!
12. Make a picture, flow chart or table that tells a story with your categories.
Who Moved the Researcher Allegiance Effect?
Entry for 18 November 2007:
The past week has been one of my busiest. Beth and I had to present the roll-out of the 2007 Person-Centred/Experiential therapy meta-analysis on Thursday at Scottish SPR. We were analysing studies up until 9pm on Wednesday, with Beth sending me analyses after that as she finished them and as I gradually worked my way through the powerpoint slides. Although the new data set was much smaller than the previous one (29 vs. 112 studies), the total number of clients is large and most of the results were remarkably consistent: Pre-post effects pretty much the same; controlled effects a bit larger, if anything; comparative effects still hovering around zero.
Somewhere around midnight, however, we discovered that the researcher allegiance effect had disappeared. (This is the correlation between research pro vs. con theoretical allegiance and effect size.) This had been a regular feature of the last 3 iterations of the analysis, even getting larger with time; and of course it’s a general finding in the larger psychotherapy outcome literature (e.g., Luborsky et al., 1999). Now, instead of a correlation coefficient of -.59 (p < .05), it was a measly -.26, which is not even close to statistical significance with n = 29. Without a significant allegiance effect, there is no justification for controlling for it. I was concerned but also amused. Researcher allegiance is an important part of our overall analysis of the why CBT sometimes appears to be superior to person-centred therapy; but I always get a kick out of it when results surprise me. It reinforces my belief in research and science in general. What’s the point of doing science if you don’t get surprised some of the time?
Mick was not amused when I told him the next day, insisting that we keep trying until we found an allegiance effect. Apparently, he has a strong researcher allegiance to researcher allegiance effects! But the fact is that Beth and I don’t trust the finding either, and will feel much better once we have included the other 20+ studies still out there waiting for us to get to them. Statistical power isn’t really enough here and we haven’t yet had a look round for outliers. Stay tuned for further developments…
Reference: Luborsky, L., Diguer, L., Seligman, D.A., Rosenthal, R., Krause, E.D., Johnson, S., Halperin, G., Bishop, M., Berman, J.S., & Schweizer, E. (1999). The researcher’s own therapy allegiances: A “wild card” in comparisons of treatment efficacy. Clinical Psychology,: Science and Practice, 6, 95- 106.
The past week has been one of my busiest. Beth and I had to present the roll-out of the 2007 Person-Centred/Experiential therapy meta-analysis on Thursday at Scottish SPR. We were analysing studies up until 9pm on Wednesday, with Beth sending me analyses after that as she finished them and as I gradually worked my way through the powerpoint slides. Although the new data set was much smaller than the previous one (29 vs. 112 studies), the total number of clients is large and most of the results were remarkably consistent: Pre-post effects pretty much the same; controlled effects a bit larger, if anything; comparative effects still hovering around zero.
Somewhere around midnight, however, we discovered that the researcher allegiance effect had disappeared. (This is the correlation between research pro vs. con theoretical allegiance and effect size.) This had been a regular feature of the last 3 iterations of the analysis, even getting larger with time; and of course it’s a general finding in the larger psychotherapy outcome literature (e.g., Luborsky et al., 1999). Now, instead of a correlation coefficient of -.59 (p < .05), it was a measly -.26, which is not even close to statistical significance with n = 29. Without a significant allegiance effect, there is no justification for controlling for it. I was concerned but also amused. Researcher allegiance is an important part of our overall analysis of the why CBT sometimes appears to be superior to person-centred therapy; but I always get a kick out of it when results surprise me. It reinforces my belief in research and science in general. What’s the point of doing science if you don’t get surprised some of the time?
Mick was not amused when I told him the next day, insisting that we keep trying until we found an allegiance effect. Apparently, he has a strong researcher allegiance to researcher allegiance effects! But the fact is that Beth and I don’t trust the finding either, and will feel much better once we have included the other 20+ studies still out there waiting for us to get to them. Statistical power isn’t really enough here and we haven’t yet had a look round for outliers. Stay tuned for further developments…
Reference: Luborsky, L., Diguer, L., Seligman, D.A., Rosenthal, R., Krause, E.D., Johnson, S., Halperin, G., Bishop, M., Berman, J.S., & Schweizer, E. (1999). The researcher’s own therapy allegiances: A “wild card” in comparisons of treatment efficacy. Clinical Psychology,: Science and Practice, 6, 95- 106.
Sunday, November 11, 2007
Psychological Services Research Centre Opening Day
Entry for 10 November 2007:
In 1984-85, as I have written previously, we spent a stimulating year in Sheffield, England, working with David Shapiro and his team. Two members of this team were Gillian Hardy and Michael Barkham. During that year, we worked on several projects, the most important of which was a Comprehensive Process Analysis of insight events in cognitive-behavioural and psychodynamic-interpersonal therapies. Several years later, David and the team moved to the University of Leeds, and eventually dispersed, with Gill returning to Sheffield to teach on the new Clinical Psychology course, while Michael stayed on at Leeds and David finally took early retirement. Eventually both Michael and Gillian got themselves promoted to Professor at their respective universities.
Now, however, Michael has taken a Professorship at the University of Sheffield as part of a scheme to head up the new Centre for Psychological Services Research, creating a collaboration with Gill and Glenys Parry, another 1980’s Sheffield alum, plus John Brazier, a health economist, creating a collaboration between the School of Health and Related Related (SHARR) and Psychology. The idea of the new centre is a timely and important one: To integrate health services research (whose major source disciplines are epidemiology, economics, public health) with psychotherapy research (source discipline: psychology).
Yesterday (Friday) the four of them put on a one-day conference to mark the opening the new centre. There various speeches by university and NHS dignitaries, and the four and others associated with the centre presented their vision for it, including a moving music/video presentation by a service user (“mental health consumer” in the US) named Julie Coleman.
Bruce Wampold then gave a comprehensive keynote address reviewing what we know from psychotherapy research about what affects outcome. Mike Lambert has offered a widely cited break-down of the variance accounting for therapy outcome (e.g., 30% due to therapeutic relationship; 15% due to technique/model), but I found Bruce’s analysis more empirically grounded and useful, in descending order of size:
Bruce’s own research sometimes gets quite technical, for example using multiple-level hierarchical modelling. This work makes me somewhat nervous, partly because I find it difficult to follow, but also because I have observed that the more complex the statistical methods used, the more assumptions are made and the harder it is explain the results to practitioners. I prefer as a matter of principle to use simpler statistics wherever possible; however, sometimes it is not possible…
After lunch it was the turn the turn of various outside collaborators of the centre, mostly “macro” folks, who talked about health economics and a large scale community psychology type intervention (Dave Richards on an evaluation of para-professional helpers delivering a telephone-based guided self-help program for depression). After three of these presentations, I felt a bit on foreign territory as I began my presentation, especially after Dave Richards’ remarks about not wanting to get lost in “minutiae”. Nevertheless, I launched into an updated version of my SPR-Wisconsin paper on Change Process Research genres (see Blog entry for 23 June 2007), building on Gill’s presentation from the morning. In the end, the presentation seemed to go over pretty well, although I was uncharacteristically nervous and given that it was near the end of a long day. Several people told me afterwards over tea that they appreciated my comments on problems with the poor quality of much of the qualitative research being produced today and the need for greater variety in qualitative research data collection and analysis methods.
Finally, Tony Roth, whom I had met at the BACP research conference last May, made brief comments and chaired an open discussion and question-answer session. The panellists were asked to identify themes or general impressions of the day. Here are my main thoughts:
1. I learned a lot about contextual or “macro” stuff that I didn’t know about. For example, the health economics concept of Quality Adjusted Life Years (QALYs) for estimating benefits of therapy. (You use a quality of life weight which varies from 1 = perfect health to 0 = so miserable that the person would just as soon be dead; this gets multiplied by the number of years, e.g., that a benefit of therapy might be experienced over).
2. There was a general consensus in favour of theoretical, disciplinary and methodological pluralism. Therapeutic mono-culture was universally decried; multiple methods was the order of the day. This was unsurprisingly, given the nature of the occasion and the centre, but it was still encouraging and refreshing, and led to an absence of academic oneupsmanship and a generally collegial conversation.
The last question from the audience was, “How do you think the £170 million pounds allocated last week under the Leyard initiative to promoting access to mental health treatment should be spent?” Everyone knows that it is ear-marked for providing CBT for people whose anxiety/depression are keeping them on disability and unemployment roles. The health economists among us had explained how poorly thought out this initiative is (apparently the economic modelling was done by Lord Leyard on the back of an envelope). I have been waiting for someone to ask me this question since I first heard about the initiative 18 months ago, so I piped up, “What I think the money should really be used for is doing the hard research into the factors that keep people on disability and unemployed, that is, the culture of poverty and deprivation that is behind their employment problems, and what people need to move out of that. Otherwise, as a friend of mine [John McLeod] said, we might want to start planning research proposals for on these problems for 5 to 10 years form now, when the initiative fails!”
In 1984-85, as I have written previously, we spent a stimulating year in Sheffield, England, working with David Shapiro and his team. Two members of this team were Gillian Hardy and Michael Barkham. During that year, we worked on several projects, the most important of which was a Comprehensive Process Analysis of insight events in cognitive-behavioural and psychodynamic-interpersonal therapies. Several years later, David and the team moved to the University of Leeds, and eventually dispersed, with Gill returning to Sheffield to teach on the new Clinical Psychology course, while Michael stayed on at Leeds and David finally took early retirement. Eventually both Michael and Gillian got themselves promoted to Professor at their respective universities.
Now, however, Michael has taken a Professorship at the University of Sheffield as part of a scheme to head up the new Centre for Psychological Services Research, creating a collaboration with Gill and Glenys Parry, another 1980’s Sheffield alum, plus John Brazier, a health economist, creating a collaboration between the School of Health and Related Related (SHARR) and Psychology. The idea of the new centre is a timely and important one: To integrate health services research (whose major source disciplines are epidemiology, economics, public health) with psychotherapy research (source discipline: psychology).
Yesterday (Friday) the four of them put on a one-day conference to mark the opening the new centre. There various speeches by university and NHS dignitaries, and the four and others associated with the centre presented their vision for it, including a moving music/video presentation by a service user (“mental health consumer” in the US) named Julie Coleman.
Bruce Wampold then gave a comprehensive keynote address reviewing what we know from psychotherapy research about what affects outcome. Mike Lambert has offered a widely cited break-down of the variance accounting for therapy outcome (e.g., 30% due to therapeutic relationship; 15% due to technique/model), but I found Bruce’s analysis more empirically grounded and useful, in descending order of size:
1. Client pre-therapy status on whatever the outcome measure is: 40 – 50% of the variance on that measure. This is by far the best predictor. The variability in this and the other estimates depends largely on the type of measure being used.The remaining 19 – 36 % of the variance? Bruce didn’t say, but there may be additional client pre-therapy characteristics, such as problem chronicity or duration (as hypothesized by David Clarke in his attack on the new centre team’s most recent CORE analysis, Stiles et al., 2007) in the latest issue of Psychological Medicine). Most likely, the rest is “error”, or, as I have long suspected, mysterious, chaotic 10-way interaction effects, essentially indistinguishable from error.
2. Getting therapy (vs. not getting therapy): about 13% of the variance
3. Therapeutic alliance: 5 – 9% of the variance (about half of this attributable to the therapist).
4. Therapist: 5 – 8 % of the variance. (This partly overlaps with alliance.)
5. Type of therapy: at most, 1% of the variance.
Bruce’s own research sometimes gets quite technical, for example using multiple-level hierarchical modelling. This work makes me somewhat nervous, partly because I find it difficult to follow, but also because I have observed that the more complex the statistical methods used, the more assumptions are made and the harder it is explain the results to practitioners. I prefer as a matter of principle to use simpler statistics wherever possible; however, sometimes it is not possible…
After lunch it was the turn the turn of various outside collaborators of the centre, mostly “macro” folks, who talked about health economics and a large scale community psychology type intervention (Dave Richards on an evaluation of para-professional helpers delivering a telephone-based guided self-help program for depression). After three of these presentations, I felt a bit on foreign territory as I began my presentation, especially after Dave Richards’ remarks about not wanting to get lost in “minutiae”. Nevertheless, I launched into an updated version of my SPR-Wisconsin paper on Change Process Research genres (see Blog entry for 23 June 2007), building on Gill’s presentation from the morning. In the end, the presentation seemed to go over pretty well, although I was uncharacteristically nervous and given that it was near the end of a long day. Several people told me afterwards over tea that they appreciated my comments on problems with the poor quality of much of the qualitative research being produced today and the need for greater variety in qualitative research data collection and analysis methods.
Finally, Tony Roth, whom I had met at the BACP research conference last May, made brief comments and chaired an open discussion and question-answer session. The panellists were asked to identify themes or general impressions of the day. Here are my main thoughts:
1. I learned a lot about contextual or “macro” stuff that I didn’t know about. For example, the health economics concept of Quality Adjusted Life Years (QALYs) for estimating benefits of therapy. (You use a quality of life weight which varies from 1 = perfect health to 0 = so miserable that the person would just as soon be dead; this gets multiplied by the number of years, e.g., that a benefit of therapy might be experienced over).
2. There was a general consensus in favour of theoretical, disciplinary and methodological pluralism. Therapeutic mono-culture was universally decried; multiple methods was the order of the day. This was unsurprisingly, given the nature of the occasion and the centre, but it was still encouraging and refreshing, and led to an absence of academic oneupsmanship and a generally collegial conversation.
The last question from the audience was, “How do you think the £170 million pounds allocated last week under the Leyard initiative to promoting access to mental health treatment should be spent?” Everyone knows that it is ear-marked for providing CBT for people whose anxiety/depression are keeping them on disability and unemployment roles. The health economists among us had explained how poorly thought out this initiative is (apparently the economic modelling was done by Lord Leyard on the back of an envelope). I have been waiting for someone to ask me this question since I first heard about the initiative 18 months ago, so I piped up, “What I think the money should really be used for is doing the hard research into the factors that keep people on disability and unemployed, that is, the culture of poverty and deprivation that is behind their employment problems, and what people need to move out of that. Otherwise, as a friend of mine [John McLeod] said, we might want to start planning research proposals for on these problems for 5 to 10 years form now, when the initiative fails!”
Focusing and PE-EFT
Entry for 8 November 2007:
For several reasons, I haven’t really covered Focusing in my EFT courses here in Scotland. For one thing, there seem to be plenty of other people teaching Focusing in Scotland, even on our diploma course. I hate boring people by going over old stuff, and when I ask, it’s usually fairly far down people’s list of topics they want to hear about. So I haven’t been confident that I had anything distinctive to say about Focusing.
I do, however, like to cover either Focusing or Clearing a Space, and last summer in EFT we did the latter, so I thought I’d give Focusing a try in EFT-2 this time around. In addition, I’d picked up what looked to be a very nice video of Ann Weiser Cornell at the APA Humanistic Therapy conference last August. I really enjoy watching Ann work, and am intrigued by her radical approach to Focusing.
I had shown the first part of Ann’s DVD the previous night in EFT-3, and we really enjoyed what we’d seen. However, it felt very unstructured compared to the Process-Experiential version of Focusing, which is fairly close to classical Gendlinian Focusing. Drawing on Mia Leijssen’s writings on Focusing, it was an easy matter in 1991 for me to frame Focusing as a PE task. Ann’s Focusing, in contrast, feels more free flowing and elegant, with fewer different bits; for example, she doesn’t do clearing a space and doesn’t seem to do much with symbolizing and checking for fit. It is lovely to watch her radically accepting manner, but I wondered if it would prove to be confusing for my learners if I showed the DVD as an example of Focusing work while at the same encouraging them to practice the PE-EFT version. I decided to go for it, anyway.
Ann titles the video “Focusing with a Story-telling Client”, but in PE-EFT terms, the client expresses a mixture of externalizing, purely conceptual, and attending modes of engagement, and presents emotion-processing difficulties around secondary reactive (with some primary maladaptive) anger. He offers several markers: Narrative Pressure, Conflict Split, Unfinished Business.
Instead of following these other possibilities, we were struck by how Ann takes the client’s initial statement of problematic anger as a Focusing marker, and tracks this at least as far as the first 20 minutes of the sessions (as far as we’ve seen so far), even when the client goes off into narrative and abstraction. This generates a gradual deepening process, and results in kinds of therapeutic work which probably would not have occurred if one of the other tasks had been followed instead. It’s always fun to watch a master work with such familiar material in a different way!
Moreover, on this second viewing of the first part of the video, it because clear that Ann’s practice is not that far from classical (or even PE-EFT) Focusing work. There is a clear therapeutic task focus; Marker (Step 1) and Attending (Step 2) phases to the work also occur; she doesn’t do much explicit symbolizing or checking, but around minute 20, she begins to move to Asking (Step 4). That was good enough for me!
It became clear over the course of the rest of the training session that PE-EFT has a particular and useful take on Focusing:
1. PE-EFT articulates a clear set of markers for when to use Focusing in a systematic way, and when other tasks make more sense to implement.
2. Focusing micro-processes (articulated by Leijssen) -- such as checking, finding a working distance, and receiving -- support other PE-EFT tasks, especially Chairwork.
3. The Emotion-Focused Therapy perspective suggests the importance of an additional exploratory question in the Asking phase (Step 4): “What does it need?” This question produced several Felt Shifts last night.
4. The framework of multiple modes of engagement provides a useful way of looking at the different steps of Focusing:
-Step 2, Asking: Mindful Attending
-Step 3, Labelling/checking: Experiential Search
-Step 4, Asking: Experiential Search
-Step 5, Receiving: Appreciating
-Step 6, Carrying Forward: Action Planning
Note: Ann’s use of “something…” to point toward the unclear felt sense (or emotion scheme) is an excellent example of a response that supports client Experiential Search of the unclear edges of experience.
5. Self-soothing processes can be accessed using Focusing, and provide an alternative or complement to using a chair process for this.
6. Emotion scheme exploration could also be done using Focusing to help the client access the different elements of a felt sense: Perceptual-situational; Conceptual-verbal; bodily-expressive; experienced emotion; and action tendency.
For several reasons, I haven’t really covered Focusing in my EFT courses here in Scotland. For one thing, there seem to be plenty of other people teaching Focusing in Scotland, even on our diploma course. I hate boring people by going over old stuff, and when I ask, it’s usually fairly far down people’s list of topics they want to hear about. So I haven’t been confident that I had anything distinctive to say about Focusing.
I do, however, like to cover either Focusing or Clearing a Space, and last summer in EFT we did the latter, so I thought I’d give Focusing a try in EFT-2 this time around. In addition, I’d picked up what looked to be a very nice video of Ann Weiser Cornell at the APA Humanistic Therapy conference last August. I really enjoy watching Ann work, and am intrigued by her radical approach to Focusing.
I had shown the first part of Ann’s DVD the previous night in EFT-3, and we really enjoyed what we’d seen. However, it felt very unstructured compared to the Process-Experiential version of Focusing, which is fairly close to classical Gendlinian Focusing. Drawing on Mia Leijssen’s writings on Focusing, it was an easy matter in 1991 for me to frame Focusing as a PE task. Ann’s Focusing, in contrast, feels more free flowing and elegant, with fewer different bits; for example, she doesn’t do clearing a space and doesn’t seem to do much with symbolizing and checking for fit. It is lovely to watch her radically accepting manner, but I wondered if it would prove to be confusing for my learners if I showed the DVD as an example of Focusing work while at the same encouraging them to practice the PE-EFT version. I decided to go for it, anyway.
Ann titles the video “Focusing with a Story-telling Client”, but in PE-EFT terms, the client expresses a mixture of externalizing, purely conceptual, and attending modes of engagement, and presents emotion-processing difficulties around secondary reactive (with some primary maladaptive) anger. He offers several markers: Narrative Pressure, Conflict Split, Unfinished Business.
Instead of following these other possibilities, we were struck by how Ann takes the client’s initial statement of problematic anger as a Focusing marker, and tracks this at least as far as the first 20 minutes of the sessions (as far as we’ve seen so far), even when the client goes off into narrative and abstraction. This generates a gradual deepening process, and results in kinds of therapeutic work which probably would not have occurred if one of the other tasks had been followed instead. It’s always fun to watch a master work with such familiar material in a different way!
Moreover, on this second viewing of the first part of the video, it because clear that Ann’s practice is not that far from classical (or even PE-EFT) Focusing work. There is a clear therapeutic task focus; Marker (Step 1) and Attending (Step 2) phases to the work also occur; she doesn’t do much explicit symbolizing or checking, but around minute 20, she begins to move to Asking (Step 4). That was good enough for me!
It became clear over the course of the rest of the training session that PE-EFT has a particular and useful take on Focusing:
1. PE-EFT articulates a clear set of markers for when to use Focusing in a systematic way, and when other tasks make more sense to implement.
2. Focusing micro-processes (articulated by Leijssen) -- such as checking, finding a working distance, and receiving -- support other PE-EFT tasks, especially Chairwork.
3. The Emotion-Focused Therapy perspective suggests the importance of an additional exploratory question in the Asking phase (Step 4): “What does it need?” This question produced several Felt Shifts last night.
4. The framework of multiple modes of engagement provides a useful way of looking at the different steps of Focusing:
-Step 2, Asking: Mindful Attending
-Step 3, Labelling/checking: Experiential Search
-Step 4, Asking: Experiential Search
-Step 5, Receiving: Appreciating
-Step 6, Carrying Forward: Action Planning
Note: Ann’s use of “something…” to point toward the unclear felt sense (or emotion scheme) is an excellent example of a response that supports client Experiential Search of the unclear edges of experience.
5. Self-soothing processes can be accessed using Focusing, and provide an alternative or complement to using a chair process for this.
6. Emotion scheme exploration could also be done using Focusing to help the client access the different elements of a felt sense: Perceptual-situational; Conceptual-verbal; bodily-expressive; experienced emotion; and action tendency.
Monday, November 05, 2007
Fireworks in Hyndland
Entry for 4 November 2007:
Guy Fawkes Day is tomorrow (5 November), but most people have been celebrating this weekend. Actually, it seemed quieter than last year until about 7:30 tonight, when a large fireworks display started in the Rugby Field about a block behind our flat. Going into the second bedroom, which we have now fixed up as a study, I turned off the lights so we could see them better. We were treated to a half hour fireworks show that seemed to go on and on, starting up again every time we thought they’d finished, and finally just stopping without the extravaganza blow-out finale typical of American fireworks performances. No matter! We enjoyed our Guy Fawkes Day celebration from the comfort and warmth of our flat, an unexpected bonus of living in Hyndland.
Guy Fawkes Day is tomorrow (5 November), but most people have been celebrating this weekend. Actually, it seemed quieter than last year until about 7:30 tonight, when a large fireworks display started in the Rugby Field about a block behind our flat. Going into the second bedroom, which we have now fixed up as a study, I turned off the lights so we could see them better. We were treated to a half hour fireworks show that seemed to go on and on, starting up again every time we thought they’d finished, and finally just stopping without the extravaganza blow-out finale typical of American fireworks performances. No matter! We enjoyed our Guy Fawkes Day celebration from the comfort and warmth of our flat, an unexpected bonus of living in Hyndland.
Tuesday, October 30, 2007
If I Ran the Zoo: A Modest Proposal for Training the Trainers
Entry for 29 October 2007:
I. Context. I’ve been to London to a Training the Trainers meeting on a grant obtained by Sue Wheeler (U Leicester) and Nancy Rowland (BACP). After several years of trying, they managed to get funding from ESRC (Economic and Social Research Council) under a grant program entitled Researcher Development Initiative (RDI). They managed to rope John McLeod and I into this, and so we came along today for a stimulating discussion at the University Women’s Club in central London. (This is club that women at any university in the UK can join, and an inexpensive, welcoming environment, including accommodation and meeting space, in the centre of London. The overall impression is pleasant, rather quaint and slightly shabby-genteel.)
I agreed to be part of this because I have strong feelings about research training and am continuing to develop my thinking on the topic in what I see as creative directions. Throughout the day today I was aware of a real danger that we would slip into familiar, stock ways of thinking about research training, ways that could potentially “kill the spirit”, and ultimately prove to be self-defeating.
I began this morning with a plea for an experiential approach to research training. This was listened to, apparently appreciated… and assimilated into an “immersion” process to be tacked onto the front of a week-long short course in a form what threatened to be a traditionally-structured curriculum. At the end of the day, sensing my disquiet, Nancy turned to me and asked me, “Robert, if it were entirely up to you how to organize this, how would you do it?” I paused, and then began, quoting Theodore Geisel (known to millions of American children as Dr. Seuss), “If I ran the zoo…” and I went on, “I would start by identifying a set of research activities that students are likely to find highly relevant to their practice, and then help the trainers learn how to help their students learn how to carry these out.”
The following is an elaboration of the rest of my reply:
II. Working Assumptions. First, based on 30 years of teaching research methods to undergraduate and postgraduate students, I start from the assumption that there are two kinds of counselling folks (i.e., counsellors/therapists and counsellors/therapists-in-training):
Group A. Most counselling folks are not that interested in research. (This is understandable, given their background and motivation for studying counselling.) Forcing them to do research, or subjecting them to lectures that they experience as dry and unrelated to practice is counter-productive and may lead to resentment and increased antipathy to research, that is to say, it can do more harm than good. For these folks, research training needs to be experientially-based and to emphasize relevance to practice. This training can introduce them to research and show them that it can be useful and interesting, helping them deepen their appreciation for and interest in research, in some cases helping them moving from Group A to Group B.
Group B. Some counselling folks are naturally interested in research and will benefit from research training that includes learning about philosophy of science issues and a range of formal research methods -- as long as it is done in an interesting, open way that doesn’t kill their native interest.
Right now, as far as I can tell Group A corresponds to the great majority of students in postgraduate diploma courses in counselling, such as the one at U of Strathclyde, while Group B corresponds to our MSc Counselling students. Clinical psychology postgraduate students are actually not that different, but they are socialized to pretend they are in Group B, when actually most of them are in Group A. I suspect that the students in the new Counselling Psychology Doctorate course are like this also, a mixture of Groups A & B. My preference would be to start them off with a Group A-type approach, and then help them move on to Group B.
For Group A, I feel that training would best be focused around a set of research-related tasks that can be directly grounded in their practice as counsellors:
III. Research Tasks that are Counsellors are likely to Find Useful in Practice:
1. Evaluating whether therapy brought about change for a particular client. At the centre of the enterprise of counselling is the dual question of (a) whether a client experiences change over the course of counselling, and (b) whether counselling is responsible this change. While this is the issue that drives therapy outcome research and randomized clinical trials (RCTs), in actual practice it is addressed one client at a time, at the single case level. Thus, students should be able to come out of training having learned how to carry out systematic single case studies that can answer this double question, using Pragmatic or Hermeneutic Single Case Designs. As I have written in various articles, such designs require learning how to use both quantitative and qualitative data collection methods, and to use systematic reasoning strategies to come up with reasonable answers.
I have found that the best way to teach these designs is to carry one out on a client of one’s own, so in working with the trainers I would show them one of my cases, including video clips and qualitative and quantitative data. I would then help the trainers develop a single case research protocol that they could use with one of their own clients, so that they could offer the same thing to their own students.
2. Locating something in the literature that’s useful for working with a particular client. I would next ask the trainers to think of a difficult situation or issue with one of their current clients. I would talk to them about resources for locating literature (both research and clinical) relevant to therapeutic difficulties. As a result, they would learn how to help their students access scientific information. (This would require a training site with internet/library access for the students, perhaps broken up into pairs.)
3. Being able to draw on the relevant research evidence in order to meet challenges to their practice. The next task is probably best carried out with groups of trainers with a similar theoretical orientation. I would ask the trainers to talk about situations in which their approach to practice has been challenged as ineffective by managers, bosses, doctors, the government etc. I would then take them through the research evidence that supports their practice, for example Person-Centred/Experiential, explaining the methods used in the research, including meta-analytic techniques, with the whole idea being that this is arming them to use evidence as a weapon for dealing with challenges. I would want to make sure that they understood and owned these data well enough to be able to convincingly explain them to their students.
4. Evaluating needs or outcomes for one’s agency. After this, I would ask the trainers to think of an agency that they work for or have worked for, and to imagine what kind of information might be useful to help that agency carry out its mission more effectively. What kinds of problems is this agency running into in carrying out its mission? Would it help the agency to have a better idea about what its clientele wanted or needed? Is there a problem with waiting lists, or no shows, or ? Is the agency being challenged to demonstrate its effectiveness? Or would it find it useful to know which kinds of clients were being helped… or not helped? Identifying such problems would then provide a basis for talking about service evaluation activities, that is, simple group design surveys and outcome studies, either qualitative or quantitative, and how one should start with evaluation questions, and then find methods appropriate for answering those questions.
5. Identifying one’s own native curiosity about counselling/psychotherapy practice, and developing this into do-able research questions. Lastly, to provide a basis for encouraging students to move from these basic applied research tasks to more challenging, larger scale research, I would take the trainers through a Focusing exercise, to help them look inside in order to identify one or more topics that capture their curiosity. I would also offer them a list of key current research topics (“fronts”) appropriate to their theoretical orientation, and ask them to check these against their curiosity, to see which if any resonated with their curiosity. This would lead into issues of research supervision, helping students develop clear, answerable research questions, and helping them select research methods appropriate to answering those research questions.
And that’s what I would do if I ran zoo! (… said young Gerald McGrew.)
I. Context. I’ve been to London to a Training the Trainers meeting on a grant obtained by Sue Wheeler (U Leicester) and Nancy Rowland (BACP). After several years of trying, they managed to get funding from ESRC (Economic and Social Research Council) under a grant program entitled Researcher Development Initiative (RDI). They managed to rope John McLeod and I into this, and so we came along today for a stimulating discussion at the University Women’s Club in central London. (This is club that women at any university in the UK can join, and an inexpensive, welcoming environment, including accommodation and meeting space, in the centre of London. The overall impression is pleasant, rather quaint and slightly shabby-genteel.)
I agreed to be part of this because I have strong feelings about research training and am continuing to develop my thinking on the topic in what I see as creative directions. Throughout the day today I was aware of a real danger that we would slip into familiar, stock ways of thinking about research training, ways that could potentially “kill the spirit”, and ultimately prove to be self-defeating.
I began this morning with a plea for an experiential approach to research training. This was listened to, apparently appreciated… and assimilated into an “immersion” process to be tacked onto the front of a week-long short course in a form what threatened to be a traditionally-structured curriculum. At the end of the day, sensing my disquiet, Nancy turned to me and asked me, “Robert, if it were entirely up to you how to organize this, how would you do it?” I paused, and then began, quoting Theodore Geisel (known to millions of American children as Dr. Seuss), “If I ran the zoo…” and I went on, “I would start by identifying a set of research activities that students are likely to find highly relevant to their practice, and then help the trainers learn how to help their students learn how to carry these out.”
The following is an elaboration of the rest of my reply:
II. Working Assumptions. First, based on 30 years of teaching research methods to undergraduate and postgraduate students, I start from the assumption that there are two kinds of counselling folks (i.e., counsellors/therapists and counsellors/therapists-in-training):
Group A. Most counselling folks are not that interested in research. (This is understandable, given their background and motivation for studying counselling.) Forcing them to do research, or subjecting them to lectures that they experience as dry and unrelated to practice is counter-productive and may lead to resentment and increased antipathy to research, that is to say, it can do more harm than good. For these folks, research training needs to be experientially-based and to emphasize relevance to practice. This training can introduce them to research and show them that it can be useful and interesting, helping them deepen their appreciation for and interest in research, in some cases helping them moving from Group A to Group B.
Group B. Some counselling folks are naturally interested in research and will benefit from research training that includes learning about philosophy of science issues and a range of formal research methods -- as long as it is done in an interesting, open way that doesn’t kill their native interest.
Right now, as far as I can tell Group A corresponds to the great majority of students in postgraduate diploma courses in counselling, such as the one at U of Strathclyde, while Group B corresponds to our MSc Counselling students. Clinical psychology postgraduate students are actually not that different, but they are socialized to pretend they are in Group B, when actually most of them are in Group A. I suspect that the students in the new Counselling Psychology Doctorate course are like this also, a mixture of Groups A & B. My preference would be to start them off with a Group A-type approach, and then help them move on to Group B.
For Group A, I feel that training would best be focused around a set of research-related tasks that can be directly grounded in their practice as counsellors:
III. Research Tasks that are Counsellors are likely to Find Useful in Practice:
1. Evaluating whether therapy brought about change for a particular client. At the centre of the enterprise of counselling is the dual question of (a) whether a client experiences change over the course of counselling, and (b) whether counselling is responsible this change. While this is the issue that drives therapy outcome research and randomized clinical trials (RCTs), in actual practice it is addressed one client at a time, at the single case level. Thus, students should be able to come out of training having learned how to carry out systematic single case studies that can answer this double question, using Pragmatic or Hermeneutic Single Case Designs. As I have written in various articles, such designs require learning how to use both quantitative and qualitative data collection methods, and to use systematic reasoning strategies to come up with reasonable answers.
I have found that the best way to teach these designs is to carry one out on a client of one’s own, so in working with the trainers I would show them one of my cases, including video clips and qualitative and quantitative data. I would then help the trainers develop a single case research protocol that they could use with one of their own clients, so that they could offer the same thing to their own students.
2. Locating something in the literature that’s useful for working with a particular client. I would next ask the trainers to think of a difficult situation or issue with one of their current clients. I would talk to them about resources for locating literature (both research and clinical) relevant to therapeutic difficulties. As a result, they would learn how to help their students access scientific information. (This would require a training site with internet/library access for the students, perhaps broken up into pairs.)
3. Being able to draw on the relevant research evidence in order to meet challenges to their practice. The next task is probably best carried out with groups of trainers with a similar theoretical orientation. I would ask the trainers to talk about situations in which their approach to practice has been challenged as ineffective by managers, bosses, doctors, the government etc. I would then take them through the research evidence that supports their practice, for example Person-Centred/Experiential, explaining the methods used in the research, including meta-analytic techniques, with the whole idea being that this is arming them to use evidence as a weapon for dealing with challenges. I would want to make sure that they understood and owned these data well enough to be able to convincingly explain them to their students.
4. Evaluating needs or outcomes for one’s agency. After this, I would ask the trainers to think of an agency that they work for or have worked for, and to imagine what kind of information might be useful to help that agency carry out its mission more effectively. What kinds of problems is this agency running into in carrying out its mission? Would it help the agency to have a better idea about what its clientele wanted or needed? Is there a problem with waiting lists, or no shows, or ? Is the agency being challenged to demonstrate its effectiveness? Or would it find it useful to know which kinds of clients were being helped… or not helped? Identifying such problems would then provide a basis for talking about service evaluation activities, that is, simple group design surveys and outcome studies, either qualitative or quantitative, and how one should start with evaluation questions, and then find methods appropriate for answering those questions.
5. Identifying one’s own native curiosity about counselling/psychotherapy practice, and developing this into do-able research questions. Lastly, to provide a basis for encouraging students to move from these basic applied research tasks to more challenging, larger scale research, I would take the trainers through a Focusing exercise, to help them look inside in order to identify one or more topics that capture their curiosity. I would also offer them a list of key current research topics (“fronts”) appropriate to their theoretical orientation, and ask them to check these against their curiosity, to see which if any resonated with their curiosity. This would lead into issues of research supervision, helping students develop clear, answerable research questions, and helping them select research methods appropriate to answering those research questions.
And that’s what I would do if I ran zoo! (… said young Gerald McGrew.)
Another New Publication: Elliott & Freire (2007)
Entry for Oct 29 2007:
Gene Gendlin founded Psychotherapy: Theory, Research, Practice & Training, the house journal of the Division of Psychotherapy of the American Psychological Association. Since then it has had its ups and down, but recently it has been flourishing under the editorship of Charlie Gelso, a colleague of Clara Hill's at the University of Maryland. Last year, Charlie asked me to write a short piece for a special section of the journal marking the 50th anniversary of the publication of Carl Rogers’ famous paper on the facilitative conditions. I wrote back to Charlie asking if there were any classical person-centred folks writing commentary pieces. The answer was no. Because this offended my sense of fairness, I invited my classical colleague Beth Freire to co-author the piece with me, with each of us presenting our own view of Rogers (1957) in a kind of dialogue. Charlie got a “twofer”, and Beth and I got the experience of collaborating on the paper, which turned out to be a very nice experience. As with Elliott & Greenberg (2007), the hardest part turned out to be working within the page limit, but we managed, and were very pleased with the result, cited below with the abstract.
Elliott, R., & Freire, E. (2007). Classical Person-Centered and Experiential Perspectives on Rogers (1957). Psychotherapy, 3, 285-288.
Abstract. Rogers (1957) foreshadows the later development of the person-centered approach in North America and elsewhere. In this paper, we present contrasting perspectives on the legacy of this key paper: First, from the perspective of classical person-centered therapy, Freire describes the context for this key paper within the wider frame of Rogers’ body of work and emphasizes its continuing importance and relevance. Second, Elliott offers a personal history from the point of view of a psychotherapy researcher and process-experiential therapist. These two perspectives represent two major and distinct views of Rogers’ legacy from within his direct intellectual and therapeutic descendents.
Gene Gendlin founded Psychotherapy: Theory, Research, Practice & Training, the house journal of the Division of Psychotherapy of the American Psychological Association. Since then it has had its ups and down, but recently it has been flourishing under the editorship of Charlie Gelso, a colleague of Clara Hill's at the University of Maryland. Last year, Charlie asked me to write a short piece for a special section of the journal marking the 50th anniversary of the publication of Carl Rogers’ famous paper on the facilitative conditions. I wrote back to Charlie asking if there were any classical person-centred folks writing commentary pieces. The answer was no. Because this offended my sense of fairness, I invited my classical colleague Beth Freire to co-author the piece with me, with each of us presenting our own view of Rogers (1957) in a kind of dialogue. Charlie got a “twofer”, and Beth and I got the experience of collaborating on the paper, which turned out to be a very nice experience. As with Elliott & Greenberg (2007), the hardest part turned out to be working within the page limit, but we managed, and were very pleased with the result, cited below with the abstract.
Elliott, R., & Freire, E. (2007). Classical Person-Centered and Experiential Perspectives on Rogers (1957). Psychotherapy, 3, 285-288.
Abstract. Rogers (1957) foreshadows the later development of the person-centered approach in North America and elsewhere. In this paper, we present contrasting perspectives on the legacy of this key paper: First, from the perspective of classical person-centered therapy, Freire describes the context for this key paper within the wider frame of Rogers’ body of work and emphasizes its continuing importance and relevance. Second, Elliott offers a personal history from the point of view of a psychotherapy researcher and process-experiential therapist. These two perspectives represent two major and distinct views of Rogers’ legacy from within his direct intellectual and therapeutic descendents.
New Publication: Elliott & Greenberg (2007)
Entry for 29 October 2007:
A couple of years ago, Al Mahrer approached me about contributing an article on my and Les’ approach to therapy for a special section on Experiential Psychotherapy for the American Journal of Psychotherapy. In due course, the deadline approached and the article was rewritten, submitted, revised etc. Last week I got my copy of the issue with this article in it.
In this article, I tried to communicate the basic ideas of Process-Experiential/ Emotion-Focused Therapy (PE-EFT) as clearly and simply as possible, which at times felt a bit like writing haiku, trying to communicate richness and depth in simplicity. I’m not sure how well we succeeded but I think it was worth a try, anyway. And besides, I had always thought it would be cool to publish something in this particular journal, a classic, old-time psychotherapy journal published by the American Academy of Psychotherapists that I have been reading tables of contents, and more recently abstracts, from for many years. It was a fun project, and I hope some people find it useful. Interestingly, in an introductory piece to the special section, Al Mahrer now regrets the use of the term “experiential psychotherapy” and wonders what all the therapies grouped under its umbrella really have in common… At any rate, here is the citation and an abstract for the paper:
Elliott, R., & L.S. Greenberg. (2007). The Essence of Process-Experiential /Emotion-Focused Therapy. American Journal of Psychotherapy, 61, 241-254.
Abstract. Process-Experiential/Emotion-Focused Therapy (PE-EFT; Elliott et al., 2004; Greenberg et al., 1993) is an empirically-supported, neo-humanistic approach that integrates and updates Person-centered, Gestalt and existential therapies. In this article we first present what we see as PE-EFT’s five essential features, namely neo-humanistic values, process-experiential emotion theory, person-centered but process-guiding relational stance, therapist exploratory response style, and marker-guided task strategy. Next, we summarize six treatment principles that guide therapists in carrying out this therapy: achieving empathic attunement, fostering an empathic, caring therapeutic bond, facilitating task collaboration, helping the client process experience appropriately to the task, supporting completion of key client tasks, and fostering client development and empowerment. In general PE-EFT is an approach that seeks to help clients transform contradictions and impasses into wellsprings for growth.
A couple of years ago, Al Mahrer approached me about contributing an article on my and Les’ approach to therapy for a special section on Experiential Psychotherapy for the American Journal of Psychotherapy. In due course, the deadline approached and the article was rewritten, submitted, revised etc. Last week I got my copy of the issue with this article in it.
In this article, I tried to communicate the basic ideas of Process-Experiential/ Emotion-Focused Therapy (PE-EFT) as clearly and simply as possible, which at times felt a bit like writing haiku, trying to communicate richness and depth in simplicity. I’m not sure how well we succeeded but I think it was worth a try, anyway. And besides, I had always thought it would be cool to publish something in this particular journal, a classic, old-time psychotherapy journal published by the American Academy of Psychotherapists that I have been reading tables of contents, and more recently abstracts, from for many years. It was a fun project, and I hope some people find it useful. Interestingly, in an introductory piece to the special section, Al Mahrer now regrets the use of the term “experiential psychotherapy” and wonders what all the therapies grouped under its umbrella really have in common… At any rate, here is the citation and an abstract for the paper:
Elliott, R., & L.S. Greenberg. (2007). The Essence of Process-Experiential /Emotion-Focused Therapy. American Journal of Psychotherapy, 61, 241-254.
Abstract. Process-Experiential/Emotion-Focused Therapy (PE-EFT; Elliott et al., 2004; Greenberg et al., 1993) is an empirically-supported, neo-humanistic approach that integrates and updates Person-centered, Gestalt and existential therapies. In this article we first present what we see as PE-EFT’s five essential features, namely neo-humanistic values, process-experiential emotion theory, person-centered but process-guiding relational stance, therapist exploratory response style, and marker-guided task strategy. Next, we summarize six treatment principles that guide therapists in carrying out this therapy: achieving empathic attunement, fostering an empathic, caring therapeutic bond, facilitating task collaboration, helping the client process experience appropriately to the task, supporting completion of key client tasks, and fostering client development and empowerment. In general PE-EFT is an approach that seeks to help clients transform contradictions and impasses into wellsprings for growth.
Sunday, October 28, 2007
Floaters
Entry for 28 October 2007:
A couple of weeks ago, I suddenly developed a weird eye condition commonly called “floaters”: Coming home from a performance at the Star Folk Club on a Thursday night, I suddenly noticed strange threads in the right visual field of my right eye. I initially took these to be cobwebs or long, knotted hairs hanging down from my hat. I kept trying to brush them out of the way, without success. When I described them to Diane, she called them “floaters”, which I then looked up on the internet. Apparently, the vitreous part of my eye has shrunk enough to pull away from my retina; these are bits of crud that result from process. There is also some chance of retinal detachment, which could lead to blindness. When I phoned my GP, I was given an appointment the following week. When I finally got in to see him, he sent straight over to Gartnavel Hospital to have it evaluated. After a couple of hours waiting in the Eye Casualty Department, a nice ophthalmologist ran me through several tests and declared my retina to be undamaged. Maybe they would go away in a couple of months, she said… or maybe not. The floaters are more a nuisance than anything else, distracting me when I’m trying to read. Because they are constantly moving, my visual system is having trouble editing them out of reality, in case they turn out to be real. In the meantime, they are a source of entertainment during long, boring meetings. A surreal experience!
A couple of weeks ago, I suddenly developed a weird eye condition commonly called “floaters”: Coming home from a performance at the Star Folk Club on a Thursday night, I suddenly noticed strange threads in the right visual field of my right eye. I initially took these to be cobwebs or long, knotted hairs hanging down from my hat. I kept trying to brush them out of the way, without success. When I described them to Diane, she called them “floaters”, which I then looked up on the internet. Apparently, the vitreous part of my eye has shrunk enough to pull away from my retina; these are bits of crud that result from process. There is also some chance of retinal detachment, which could lead to blindness. When I phoned my GP, I was given an appointment the following week. When I finally got in to see him, he sent straight over to Gartnavel Hospital to have it evaluated. After a couple of hours waiting in the Eye Casualty Department, a nice ophthalmologist ran me through several tests and declared my retina to be undamaged. Maybe they would go away in a couple of months, she said… or maybe not. The floaters are more a nuisance than anything else, distracting me when I’m trying to read. Because they are constantly moving, my visual system is having trouble editing them out of reality, in case they turn out to be real. In the meantime, they are a source of entertainment during long, boring meetings. A surreal experience!
The ScotCon Research Community
Entry to 28 October 2007:
ScotCon, the Scottish Consortium for Psychotherapy and Counselling Research, has several functions, including organizing Scottish SPR meetings, and coordinating research efforts at various Scottish universities. Now we are adding two new functions: a research support group and a series of conferences on single case research methods.
Last Thursday was the first real meeting of the ScotCon Research Community. Mick, whose idea it was to do this, was out of town, so Brian Rodgers and I were caught a bit by surprise, when we were suddenly confronted with a diverse collection of 22 diverse MSc, Counselling Doctorate, and Research PhD students. (We had been expecting the usual 6 – 10 MSc students, and hadn’t really taken on board the idea that most of the other people that Mick had invited would actually show up.) Looking around the full room, my first impulse was to panic: How can we possibly meet the needs of all these different people? Then I took a deep breath, and said, “OK! Welcome to our Research Community! Our goal here is to create a way of working together that will work for us, and meet your research needs.”
We then went around the room, each of us spending a minute or so reporting in on our current state of progress on our research projects. (I was very grateful that Mick had previously negotiated us down from the 5 min each that I had preferred, or we would have been there all night…) There were 9 beginning-level MSc students, working on their ethics proposals; 3 advanced level MSc students, collecting and analyzing their data; 7 first year Counselling Psychology Doctorate students, still bright and bushy-tailed even after a day of classes and anxious about their ethics proposals; two research PhD students; and a sabbatical visiting scholar (Mikio).
We then split up into two groups: About 15 came along to hear what I had to say about research ethics and Strathclyde’s ethics review process, while the rest stayed in the main room with Brian to do a workshop on how to analyze Tiane’s interview data on ethics in the Person-Centred Approach. I guess it was Ethics Night!
Then it was back downstairs again for the Scottish SPR meeting, featuring the Aberdeen Early Trauma research group. At the end of the evening, after a very stimulating presentation from Linda Treliving et al., Brian and I walked back to the train station. We felt exhausted but pleased at how the day had gone. We don’t know how the new Research Community will evolve over the coming months, but it certainly seemed like a good beginning.
ScotCon, the Scottish Consortium for Psychotherapy and Counselling Research, has several functions, including organizing Scottish SPR meetings, and coordinating research efforts at various Scottish universities. Now we are adding two new functions: a research support group and a series of conferences on single case research methods.
Last Thursday was the first real meeting of the ScotCon Research Community. Mick, whose idea it was to do this, was out of town, so Brian Rodgers and I were caught a bit by surprise, when we were suddenly confronted with a diverse collection of 22 diverse MSc, Counselling Doctorate, and Research PhD students. (We had been expecting the usual 6 – 10 MSc students, and hadn’t really taken on board the idea that most of the other people that Mick had invited would actually show up.) Looking around the full room, my first impulse was to panic: How can we possibly meet the needs of all these different people? Then I took a deep breath, and said, “OK! Welcome to our Research Community! Our goal here is to create a way of working together that will work for us, and meet your research needs.”
We then went around the room, each of us spending a minute or so reporting in on our current state of progress on our research projects. (I was very grateful that Mick had previously negotiated us down from the 5 min each that I had preferred, or we would have been there all night…) There were 9 beginning-level MSc students, working on their ethics proposals; 3 advanced level MSc students, collecting and analyzing their data; 7 first year Counselling Psychology Doctorate students, still bright and bushy-tailed even after a day of classes and anxious about their ethics proposals; two research PhD students; and a sabbatical visiting scholar (Mikio).
We then split up into two groups: About 15 came along to hear what I had to say about research ethics and Strathclyde’s ethics review process, while the rest stayed in the main room with Brian to do a workshop on how to analyze Tiane’s interview data on ethics in the Person-Centred Approach. I guess it was Ethics Night!
Then it was back downstairs again for the Scottish SPR meeting, featuring the Aberdeen Early Trauma research group. At the end of the evening, after a very stimulating presentation from Linda Treliving et al., Brian and I walked back to the train station. We felt exhausted but pleased at how the day had gone. We don’t know how the new Research Community will evolve over the coming months, but it certainly seemed like a good beginning.
Update: Late October
Entry for 28 October 2007:
Clock change last night after Maggi’s Samhain party. Wet, windy night, rain on the windows. This morning, though, the light has come an hour earlier and the sun is shining again. We’ll regret this extra hour tonight, when the sun sets at 10 to five! I’m off on another train journey, this time to London for an initial meeting of the Training the Trainers project. Sunday is not the best time to take the train; in fact, it’s the worst, because they do repair and service work on Sundays. Today I’m going to have to take a bus from Edinburgh to Newcastle. (This time, I looked at air and bus as alternatives, but wasn’t impressed. Nothing beats the 18:08 train out of London Euston: home tomorrow night by 23.30!)
For whatever reason, the train to Edinburgh is pretty full this morning, lots families. Sun slants into the train carriage, then goes behind cloud. Wet streets flash by. Between the towns, the golf courses are full of puddles and Sunday morning golfers.
Progress report:
1. Two articles of mine have come out in the past week: one in American Journal of Psychotherapy, the other in Psychotherapy (I'll do separate entries on these soon).
2. I’ve learned a lot about the NHS Research Ethics process, and the Social Anxiety Study has now been submitted to the local NHS Research Ethics Committee, to be reviewed at their December meeting. I’ve done the application for the Practice-Based Research Protocol, and finally got it sent off to our research office last night for University (re)approval. This additional ethics process has been a real pain, and has cost the Research Clinic a couple of months of prime recruiting time, and me 4 weeks of work that I’d planned to put in on manuscripts. But it’s been necessary and I’ve learned a lot from it, which I can use in supervising students.
3. Things to look forward to: We’ve made our plans for our 3-week Christmas holiday in Ohio and California, visiting our kids and larger families. We are also in the process of setting up the guest bedroom to function also as a study for me. Yesterday we bought an Ikea table. After a couple months of waiting for the new Apple operating system (“Leopard”), I’m finally ready to buy a new home office computer, and will order it this week. Computer will go on new table in re-functioned spare bedroom.
4. Teaching: Successful new class/workshop offerings on Empathy (Monday Part-time course), Narrative Retelling (EFT-2), Psychometrics/Quantitative Questionnaire Design and Research Ethics (MSc Counselling Course).
5. As I have previously noted, the ominous Improving-Access-to-Psychological Therapies (IAPT)-But-Actually-Making-the-World-Safe-for-Complete-Domination-by-CBT movement has come to Scotland. Fortunately, we (the nonCBT approaches and in particular Person-Centred/Experiential therapies) have been offered the opportunity to make our voice heard. After some initial struggle about how to handle differences in the research evidence for Person-Centred and Process-Experiential therapies in the response we are drafting to the NHS Education Scotland’s request for advice on provision of psychological therapies in Scotland, we came up with a satisfactory strategy that everyone seems satisfied with. (Thanks to Mick for taking the lead on this!)
6. Heather, the Counselling Unit’s long-time secretary has left after 20 years at Strathclyde, to work on a big social neuroscience grant project at the U of Glasgow. This is a great opportunity for her, but has left the rest of us somewhat apprehensive about how we will do on her absence, given that she provided a kind of psychological glue to the place. As Tracey noted, Heather has been taking care of all the little bits that no one else was keeping track of. Now the question is, how many little bits are going to get lost in the shuffle? Until we are able to replace her, we will all have to do our best with grace and good humour.
7. November outlook: November is going to be a challenging month, with three presentations on the new meta-analysis, a presentation at the launch of a new research centre, and a short-course on qualitative analysis in Leicester. We would really like to celebrate American Thanksgiving this year, also! We’ll just have to see how this all falls out.
Clock change last night after Maggi’s Samhain party. Wet, windy night, rain on the windows. This morning, though, the light has come an hour earlier and the sun is shining again. We’ll regret this extra hour tonight, when the sun sets at 10 to five! I’m off on another train journey, this time to London for an initial meeting of the Training the Trainers project. Sunday is not the best time to take the train; in fact, it’s the worst, because they do repair and service work on Sundays. Today I’m going to have to take a bus from Edinburgh to Newcastle. (This time, I looked at air and bus as alternatives, but wasn’t impressed. Nothing beats the 18:08 train out of London Euston: home tomorrow night by 23.30!)
For whatever reason, the train to Edinburgh is pretty full this morning, lots families. Sun slants into the train carriage, then goes behind cloud. Wet streets flash by. Between the towns, the golf courses are full of puddles and Sunday morning golfers.
Progress report:
1. Two articles of mine have come out in the past week: one in American Journal of Psychotherapy, the other in Psychotherapy (I'll do separate entries on these soon).
2. I’ve learned a lot about the NHS Research Ethics process, and the Social Anxiety Study has now been submitted to the local NHS Research Ethics Committee, to be reviewed at their December meeting. I’ve done the application for the Practice-Based Research Protocol, and finally got it sent off to our research office last night for University (re)approval. This additional ethics process has been a real pain, and has cost the Research Clinic a couple of months of prime recruiting time, and me 4 weeks of work that I’d planned to put in on manuscripts. But it’s been necessary and I’ve learned a lot from it, which I can use in supervising students.
3. Things to look forward to: We’ve made our plans for our 3-week Christmas holiday in Ohio and California, visiting our kids and larger families. We are also in the process of setting up the guest bedroom to function also as a study for me. Yesterday we bought an Ikea table. After a couple months of waiting for the new Apple operating system (“Leopard”), I’m finally ready to buy a new home office computer, and will order it this week. Computer will go on new table in re-functioned spare bedroom.
4. Teaching: Successful new class/workshop offerings on Empathy (Monday Part-time course), Narrative Retelling (EFT-2), Psychometrics/Quantitative Questionnaire Design and Research Ethics (MSc Counselling Course).
5. As I have previously noted, the ominous Improving-Access-to-Psychological Therapies (IAPT)-But-Actually-Making-the-World-Safe-for-Complete-Domination-by-CBT movement has come to Scotland. Fortunately, we (the nonCBT approaches and in particular Person-Centred/Experiential therapies) have been offered the opportunity to make our voice heard. After some initial struggle about how to handle differences in the research evidence for Person-Centred and Process-Experiential therapies in the response we are drafting to the NHS Education Scotland’s request for advice on provision of psychological therapies in Scotland, we came up with a satisfactory strategy that everyone seems satisfied with. (Thanks to Mick for taking the lead on this!)
6. Heather, the Counselling Unit’s long-time secretary has left after 20 years at Strathclyde, to work on a big social neuroscience grant project at the U of Glasgow. This is a great opportunity for her, but has left the rest of us somewhat apprehensive about how we will do on her absence, given that she provided a kind of psychological glue to the place. As Tracey noted, Heather has been taking care of all the little bits that no one else was keeping track of. Now the question is, how many little bits are going to get lost in the shuffle? Until we are able to replace her, we will all have to do our best with grace and good humour.
7. November outlook: November is going to be a challenging month, with three presentations on the new meta-analysis, a presentation at the launch of a new research centre, and a short-course on qualitative analysis in Leicester. We would really like to celebrate American Thanksgiving this year, also! We’ll just have to see how this all falls out.
Saturday, October 20, 2007
Clarifying Narrative Retelling for Difficult or Traumatic Experiences
Entry for 18 October 2007:
I didn’t cover the Narrative Retelling Task last year in EFT-2, but thought we should this year, so that was last night’s topic. Narrative Retelling task is particularly relevant to PTSD, which is where we developed our initial formulation in the mid-90’s. Therapy is full of narratives, big and small, and we haven’t always been friendly to them in the person-centred/experiential tradition. Still, over the past 20 years, narrative has emerged as a key framework for looking at therapy, culminating in Angus & McLeod’s (2004) big handbook.
The Narrative Retelling task is an adaptation of Rice’s Systematic Evocative Unfolding, but the marker is a difficult or painful life event, rather than a puzzling personal reaction, which means that process goes forward differently. However, the task had not been systematically studied until Emily Breighner, one of my students from Toledo, took it on for her master’s and now PhD dissertation research. In the process, she has developed a revised task model, updating the one published in Learning Emotion-Focused Therapy.
However, various other tasks are wound up in traumatic difficult life events, and thus need to be sorted out in figuring how best to help clients. Last night, when we practiced the Retelling Task, this became more clear than it had previously. In particular, these related tasks include:
This, however, leaves somewhat open the question of when Retelling is the optimal task. It seems to me that the essence of the Retelling marker is an Emotional Injury of some sort. The Emotional Injury marker has been formulated by Les Greenberg and Sue Johnson in the context of Emotion(ally)-Focused Therapy for couples (EFT-C), where it is a central issue in relational distress. However, emotional injuries also motivate clients to seek individual therapy, and are wound up in a variety of presenting problems, including depression, PTSD and (I now believe) Social Anxiety. Emotional injuries stem from a variety of sources, including physical attacks of injuries (in PTSD), interpersonal betrayal or abandonment (PTSD, loss-based Depression), childhood bullying or humiliation (Social Anxiety). To the extent that the injury is experienced in a context of loss, the person will feel sadness, which will motivate them to seek comfort by telling the story of the injury, and Narrative Retelling will be an appropriate task to offer to the client. This seems to me to be a useful clarification of the Narrative Retelling marker.
One of the issues raised by participants last night was the possibility of reinforcing traumatic experiences, that is, re-traumatizing clients. This is exactly what I believe dissuades many therapists from working directly with their clients’ trauma experiences. The PE-EFT analysis of this issue is that what is needed is for the client to re-experience the trauma but in a different context, thus transforming it. And of course an experience cannot be transformed unless it is first re-activated and experienced in the moment.
The different context explains why Retelling a trauma doesn’t make it worse: Because the retelling involves a controlled re-experiencing in a caring, empathic environment, provides an antidote to the emotional injury: the person experiences their injury being attended to tenderly by a caring other, which is precisely what was missing in the traumatic event. In fact, from an attachment perspective, the most telling injury is the emotional rather than the physical injury. Being genuinely understood and prized in moments of emotional injury is inherently soothing and healing.
Angus, L.E., McLeod, J. (Eds.) (2004). The Handbook of Narrative and Psychotherapy : Practice, Theory and Research. Thousand Oaks, CA: Sage.
I didn’t cover the Narrative Retelling Task last year in EFT-2, but thought we should this year, so that was last night’s topic. Narrative Retelling task is particularly relevant to PTSD, which is where we developed our initial formulation in the mid-90’s. Therapy is full of narratives, big and small, and we haven’t always been friendly to them in the person-centred/experiential tradition. Still, over the past 20 years, narrative has emerged as a key framework for looking at therapy, culminating in Angus & McLeod’s (2004) big handbook.
The Narrative Retelling task is an adaptation of Rice’s Systematic Evocative Unfolding, but the marker is a difficult or painful life event, rather than a puzzling personal reaction, which means that process goes forward differently. However, the task had not been systematically studied until Emily Breighner, one of my students from Toledo, took it on for her master’s and now PhD dissertation research. In the process, she has developed a revised task model, updating the one published in Learning Emotion-Focused Therapy.
However, various other tasks are wound up in traumatic difficult life events, and thus need to be sorted out in figuring how best to help clients. Last night, when we practiced the Retelling Task, this became more clear than it had previously. In particular, these related tasks include:
-Unfinished Business (if the main thing is something left unsaid or undone toward an important other),All these came up last night in practice sessions, which required the work to go off sideways into the more appropriate task. This means that what people mostly learned was how to stop what you’re doing at a given moment and change to a more important (at that moment) task.
-Meaning Creation (when a sense of injustice or unfairness is primary), and
-Problem Solving (if the person is right in the middle of dealing with an ongoing difficult or traumatic situation).
This, however, leaves somewhat open the question of when Retelling is the optimal task. It seems to me that the essence of the Retelling marker is an Emotional Injury of some sort. The Emotional Injury marker has been formulated by Les Greenberg and Sue Johnson in the context of Emotion(ally)-Focused Therapy for couples (EFT-C), where it is a central issue in relational distress. However, emotional injuries also motivate clients to seek individual therapy, and are wound up in a variety of presenting problems, including depression, PTSD and (I now believe) Social Anxiety. Emotional injuries stem from a variety of sources, including physical attacks of injuries (in PTSD), interpersonal betrayal or abandonment (PTSD, loss-based Depression), childhood bullying or humiliation (Social Anxiety). To the extent that the injury is experienced in a context of loss, the person will feel sadness, which will motivate them to seek comfort by telling the story of the injury, and Narrative Retelling will be an appropriate task to offer to the client. This seems to me to be a useful clarification of the Narrative Retelling marker.
One of the issues raised by participants last night was the possibility of reinforcing traumatic experiences, that is, re-traumatizing clients. This is exactly what I believe dissuades many therapists from working directly with their clients’ trauma experiences. The PE-EFT analysis of this issue is that what is needed is for the client to re-experience the trauma but in a different context, thus transforming it. And of course an experience cannot be transformed unless it is first re-activated and experienced in the moment.
The different context explains why Retelling a trauma doesn’t make it worse: Because the retelling involves a controlled re-experiencing in a caring, empathic environment, provides an antidote to the emotional injury: the person experiences their injury being attended to tenderly by a caring other, which is precisely what was missing in the traumatic event. In fact, from an attachment perspective, the most telling injury is the emotional rather than the physical injury. Being genuinely understood and prized in moments of emotional injury is inherently soothing and healing.
Angus, L.E., McLeod, J. (Eds.) (2004). The Handbook of Narrative and Psychotherapy : Practice, Theory and Research. Thousand Oaks, CA: Sage.
Person-Centred/Experiential Therapy for Social Anxiety Study Summary
Entry for 18 October 2007:
The NRES (NHS Research Ethics Service) application asks for a research proposal, including theoretical formulation, which is nice to have as a summary:
Purpose and significance: The main purpose of this research is to validate and improve under-researched Person-Centred/Experiential psychotherapy (PCEP) approaches to Social Anxiety, thus increasing the range of effective treatments that can be offered to these clients. The approaches to be studied are Person-Centred Therapy (also known as nondirective counselling), currently used extensively in NHS primary care settings, and a newer, enhanced version of this therapy, known as Process-Experiential or Emotion-Focused Therapy. Although extensive evidence supports the use of these therapies for depression, neither has previously been studied as a treatment for Social Anxiety, a widespread psychiatric disorder with links to key social problems such as substance misuse and employment difficulties.
Theory of etiology: From the point of view of PCEPs, social anxiety is understood as a result of early experiences of social trauma stemming from shaming by family, other adults, and peers. As a result of these experiences the person develops: (a) a sense of self as incompetent and unacceptable; (b) an understanding of others as setting severe demands that can never be met (“conditions of worth”); and, as a consequence, (c) a strong inner “critic” that continually induces shame in the self; and (d) a emotional avoidance and constriction.
Theory of change: PCEPs address these four sources of social anxiety by (1) offering an empathic, caring, and genuine relationship, which (2) counters the client’s expectations of severe external judgment; this in turn (3) allows the person to begin to discover a sense of self-competence and self-affirmation, which (4) enables them to access and make use of the their full range of emotions. This then provides them with a basis both (5) to counter their inner critic and (6) to initiate assertive action with others in order to meet their needs more effectively.
Recruitment and screening: Clients with symptoms of Social Anxiety will be recruited via University and mental health service user and related websites; by newspaper announcements; by posters and flyers posted in libraries, supermarkets and GP surgeries. (Target sample: n = 20.) Screening will take place in two stages: (1) 20-30 min telephone pre-screening by researcher or team member/postgraduate student; (2) face-to-face structured diagnostic assessment (2 X 2 hr sessions) for DSM-IV Axis I and II mental health disorders, conducted by trained research staff or postgraduate students.
Therapists: Staff and research associates of the Counselling Unit, with credentials in counselling, psychotherapy or clinical psychology; also, advanced postgraduate students in counselling or counselling psychology.
Research design: A standard treatment development design will be used, appropriate to an initial investigation of a psychosocial treatment. The design is a pre-post one-group design (also known as an open clinical trial), with embedded single case design, continuous outcome assessment, and mixed method (quantitative and qualitative) self-report data collection. There will be two partially-overlapping arms within the group design, for exploring variations in the treatment approach, one a nondirective person-centred approach, the other using an enhanced form of person-centred therapy (Process-experiential/Emotion-Focused therapy). For most analyses, data from the two arms will be combined, with only exploratory comparative analyses being carried out (due to statistical power issues). The design allows assessment of outcome; estimates of causal efficacy (at the single case level using systematic case study methods); psychometric evaluation of quantitative measures; and qualitative research on client perceived outcome, helpful factors and significant events. The mixed method design allows use of methods with complementary strengths and weaknesses, thus reducing overall bias. Systematic case studies will use rigorous debiasing methods in the form of careful search for alternative explanations for apparent client change and possible causal effects of therapy.
What clients will be asked to do: (1) Telephone screening interview (20-30 min). (2) Structured diagnostic interviews (2 X 2 hrs): Structured Clinical Interview for DSM-IV (SCID-IV); Personality Disorders Questionnaire-IV; Social Phobia Inventory; Personal Questionnaire Interview; Informed Consent Form. (3) Attend up to 20 therapy sessions of 50 min each, video- and audio-recorded. (4) Before session 1; after session 8; at end of therapy; and at 6- and 18-month follow-up: Complete quantitative outcome measures (CORE-OM, Personal Questionnaire, Social Phobia Inventory, Strathclyde Inventory, Self-Relationship Questionnaire, Inventory of Interpersonal Problems, Helath Utilization Scale; 90 min). (5) After session 8; at end of therapy; and at 6- and 18-month follow-up: semi-structured qualitative interview (the Change Interview; 60 min); Consent to Release Recordings (after session 8 & end of therapy; 10 min). (6) After session 8; at end of therapy: Relational depth scale (20 min). (7) Before each session: Personal Questionnaire (1 min). (8) After each session: Complete brief self-report questionnaires (Helpful Aspects of Therapy Form, Therapeutic Relationship Scale, Working Alliance Inventory; 20 min). (9) After sessions 3, 5, 8: Relational Depth Scale (10 min). (10) Recordings of therapy sessions (for later qualitative and quantitative analyses).
What therapists will be asked to do: After each session: Complete self-report adherence questionnaires appropriate their approach, including process notes (Person-centred: Therapeutic Relationship Scale; Process-Experiential: Therapist Experiential Session Form – 3) (30 min)
Data Archive: The data collected will form a psychotherapy research archive for use over a period of at least 5 years by research team members at the University of Strathclyde. With clients' separate and additional, the data will be stored securely (in the research base in D303B until the move to the John Anderson Campus and after that in a dedicated secure storage room) under the supervision of the chief researcher or his successor. All written data will be anonymized; video/audiorecordings cannot be totally anonymized but will be stored separately and securely. This is a standard procedure in psychotherapy research.
The NRES (NHS Research Ethics Service) application asks for a research proposal, including theoretical formulation, which is nice to have as a summary:
Purpose and significance: The main purpose of this research is to validate and improve under-researched Person-Centred/Experiential psychotherapy (PCEP) approaches to Social Anxiety, thus increasing the range of effective treatments that can be offered to these clients. The approaches to be studied are Person-Centred Therapy (also known as nondirective counselling), currently used extensively in NHS primary care settings, and a newer, enhanced version of this therapy, known as Process-Experiential or Emotion-Focused Therapy. Although extensive evidence supports the use of these therapies for depression, neither has previously been studied as a treatment for Social Anxiety, a widespread psychiatric disorder with links to key social problems such as substance misuse and employment difficulties.
Theory of etiology: From the point of view of PCEPs, social anxiety is understood as a result of early experiences of social trauma stemming from shaming by family, other adults, and peers. As a result of these experiences the person develops: (a) a sense of self as incompetent and unacceptable; (b) an understanding of others as setting severe demands that can never be met (“conditions of worth”); and, as a consequence, (c) a strong inner “critic” that continually induces shame in the self; and (d) a emotional avoidance and constriction.
Theory of change: PCEPs address these four sources of social anxiety by (1) offering an empathic, caring, and genuine relationship, which (2) counters the client’s expectations of severe external judgment; this in turn (3) allows the person to begin to discover a sense of self-competence and self-affirmation, which (4) enables them to access and make use of the their full range of emotions. This then provides them with a basis both (5) to counter their inner critic and (6) to initiate assertive action with others in order to meet their needs more effectively.
Recruitment and screening: Clients with symptoms of Social Anxiety will be recruited via University and mental health service user and related websites; by newspaper announcements; by posters and flyers posted in libraries, supermarkets and GP surgeries. (Target sample: n = 20.) Screening will take place in two stages: (1) 20-30 min telephone pre-screening by researcher or team member/postgraduate student; (2) face-to-face structured diagnostic assessment (2 X 2 hr sessions) for DSM-IV Axis I and II mental health disorders, conducted by trained research staff or postgraduate students.
Therapists: Staff and research associates of the Counselling Unit, with credentials in counselling, psychotherapy or clinical psychology; also, advanced postgraduate students in counselling or counselling psychology.
Research design: A standard treatment development design will be used, appropriate to an initial investigation of a psychosocial treatment. The design is a pre-post one-group design (also known as an open clinical trial), with embedded single case design, continuous outcome assessment, and mixed method (quantitative and qualitative) self-report data collection. There will be two partially-overlapping arms within the group design, for exploring variations in the treatment approach, one a nondirective person-centred approach, the other using an enhanced form of person-centred therapy (Process-experiential/Emotion-Focused therapy). For most analyses, data from the two arms will be combined, with only exploratory comparative analyses being carried out (due to statistical power issues). The design allows assessment of outcome; estimates of causal efficacy (at the single case level using systematic case study methods); psychometric evaluation of quantitative measures; and qualitative research on client perceived outcome, helpful factors and significant events. The mixed method design allows use of methods with complementary strengths and weaknesses, thus reducing overall bias. Systematic case studies will use rigorous debiasing methods in the form of careful search for alternative explanations for apparent client change and possible causal effects of therapy.
What clients will be asked to do: (1) Telephone screening interview (20-30 min). (2) Structured diagnostic interviews (2 X 2 hrs): Structured Clinical Interview for DSM-IV (SCID-IV); Personality Disorders Questionnaire-IV; Social Phobia Inventory; Personal Questionnaire Interview; Informed Consent Form. (3) Attend up to 20 therapy sessions of 50 min each, video- and audio-recorded. (4) Before session 1; after session 8; at end of therapy; and at 6- and 18-month follow-up: Complete quantitative outcome measures (CORE-OM, Personal Questionnaire, Social Phobia Inventory, Strathclyde Inventory, Self-Relationship Questionnaire, Inventory of Interpersonal Problems, Helath Utilization Scale; 90 min). (5) After session 8; at end of therapy; and at 6- and 18-month follow-up: semi-structured qualitative interview (the Change Interview; 60 min); Consent to Release Recordings (after session 8 & end of therapy; 10 min). (6) After session 8; at end of therapy: Relational depth scale (20 min). (7) Before each session: Personal Questionnaire (1 min). (8) After each session: Complete brief self-report questionnaires (Helpful Aspects of Therapy Form, Therapeutic Relationship Scale, Working Alliance Inventory; 20 min). (9) After sessions 3, 5, 8: Relational Depth Scale (10 min). (10) Recordings of therapy sessions (for later qualitative and quantitative analyses).
What therapists will be asked to do: After each session: Complete self-report adherence questionnaires appropriate their approach, including process notes (Person-centred: Therapeutic Relationship Scale; Process-Experiential: Therapist Experiential Session Form – 3) (30 min)
Data Archive: The data collected will form a psychotherapy research archive for use over a period of at least 5 years by research team members at the University of Strathclyde. With clients' separate and additional, the data will be stored securely (in the research base in D303B until the move to the John Anderson Campus and after that in a dedicated secure storage room) under the supervision of the chief researcher or his successor. All written data will be anonymized; video/audiorecordings cannot be totally anonymized but will be stored separately and securely. This is a standard procedure in psychotherapy research.
Virgin Train Through the Lake District
Entry for 18 October 2007:
On the 5:55 Train to Birmingham. It’s now 7:30 and we’ve just left Penrith, in the Lake District. I’ve dozed most of the way from Glasgow, having taught EFT-2 until 9pm last night. We had our first frost of the season last night, and we had to scrape the ice off the car so Diane could drive me to Glasgow Central. Venus was high in the east as we drove off through the empty streets. Now the sun is about the rise; the eastern sky is pink above the mists and frosty fields. The English oaks on the hills haven’t lost their leaves yet, though, which is reassuring. I love this part of the journey, through the valleys of the Lake District.
The NRES application for the Social Anxiety study is basically finished; I’ll submit it electronically after I get back from Birmingham tomorrow. The November Research Ethics Committee docket was full when I phoned the local committee (located at Gartnavel Hospitial, a 10 min walk from our flat), so we will have to go with the December meeting. I’m about to start on the Practice-Based Research Protocol, and there is a still stack of manuscripts I need to get to.
But for now it’s off to Birmingham for a meeting of the BACP journal, Counselling and Psychotherapy Research, and it feels like a bit of breathing space for a day or two.
On the 5:55 Train to Birmingham. It’s now 7:30 and we’ve just left Penrith, in the Lake District. I’ve dozed most of the way from Glasgow, having taught EFT-2 until 9pm last night. We had our first frost of the season last night, and we had to scrape the ice off the car so Diane could drive me to Glasgow Central. Venus was high in the east as we drove off through the empty streets. Now the sun is about the rise; the eastern sky is pink above the mists and frosty fields. The English oaks on the hills haven’t lost their leaves yet, though, which is reassuring. I love this part of the journey, through the valleys of the Lake District.
The NRES application for the Social Anxiety study is basically finished; I’ll submit it electronically after I get back from Birmingham tomorrow. The November Research Ethics Committee docket was full when I phoned the local committee (located at Gartnavel Hospitial, a 10 min walk from our flat), so we will have to go with the December meeting. I’m about to start on the Practice-Based Research Protocol, and there is a still stack of manuscripts I need to get to.
But for now it’s off to Birmingham for a meeting of the BACP journal, Counselling and Psychotherapy Research, and it feels like a bit of breathing space for a day or two.
Friday, October 12, 2007
From Chaos to Movement: The Story of a Friday
Entry for 12 Oct 2007:
I freaked out this morning: At that moment, although I’d spent most of the past week learning the NRES process and filling out the very long and confusing form, it was still unclear to me how long the University’s research office and ethics committee would take to re-review the Social Anxiety Research Protocol before they would approve it for me to go ahead with the NHS ethics process. In addition, I still have the NRES application for the practice-based recall protocol, which I haven’t started yet. This is holding up three manuscripts that I am supposed to be working on for various people, which were either late or about to be. And the manuscripts are holding up my doing my part of the meta-analysis that Beth is working enthusiastically away at, and that we are supposed to present the results of at three different conferences next month (including the high profile Improving Access to Psychological Therapies conference in London).
Meanwhile, we don’t have any clients yet for either the Social Anxiety study or the Practice-Based Research Protocol study, and we are expecting 4 or 5 students to start seeing clients in the latter protocol within the next month. (And our major source of clients, GP practices, is blocked to us until we get NRES approval, which is probably going take us into January.) ….In addition, the pre-test data collection for part of the diploma course study got messed up and so far we’ve only got about a 30% return rate (vs. 85% for the part-time course). Although I woke up this morning with a feeling of dread, I’d kept this to myself since I got up. Then, as I was about to go out the door with my bike and was saying goodbye to Diane, my tale of woe came pouring out. Then, just as I was winding down (or rather up), I got a phone call from Lorna, who needed me to cover the study groups on the fulltime diploma course for her. I dashed off to work.
In the course of the morning, I visited the diploma course students in the study groups, first getting their finishing time wrong and then having to go back to them and tell them the correct time. I finally faced the fact that I had to do something about the low return rate for the diploma course study. I discovered that the Social Anxiety ethics re-approval process was in danger of going sideways and required immediate intervention to get it back on track. And I discovered that we still hadn’t sorted out the flyer and poster design for the practice-based research protocol.
The low point (and turning point) of the day came when I showed up for the afternoon fulltime large group with a pile of diploma course study forms, hoping to catch some of the nonresponders… only to discover that I had forgotten to photocopy the information and consent forms. I sat there panicking, looking at the students.
Finally, I took a deep breath and tried to explain the situation to them as best I could. It turned out that Julie Folkes-Skinner, the U of Leicester whose dissertation research it is, had confused things by giving the students envelopes with her address for them to return the forms to her directly; however, I had told them to return them to us, as we had done with the part-time course. This led to confusion; some students had put stamps on the envelopes & mailed the forms back to Julie; others had tried to turn them in to the office and been told to mail them themselves (presumably because of the missing stamps) but hadn't because of postal strike, while others just hadn't got around to it or weren’t sure if we are still interested in getting them back. I left them with a plea to do their best to get the forms back to us as soon as possible and to let me know if they were willing to take part in Level II of the study. This at least clarified where the problem was and boded well for salvaging a decent return rate.
I went back to my office, to meet with Isabel on her MSc thesis about the study she is planning on counselling with the dying. Louise at the research office phoned a couple of times and grilled me about aspects of the Social Anxiety study, which began to look like it might get unstuck. Brian and I finalized the Practice-Based Research Protocol, making it more appealing. Beth had given me three important studies that she had analyzed, and somewhere in my wanderings I realized that it might be possible for us to take the meta-analysis to next month’s conferences without us both analyzing all the studies, that we could present a relatively complete set of studies combining our separate analyses, and then later (in December & January) analyze each other’s studies in order to check reliability as we had planned. Then, Lorna announced that she had gotten the cooperation of the Tom Allen Centre to give information about our two protocols to the clients on their long waiting list. Before going home, we had a very productive research committee meerting in which we made significant progress planning how we are going run the student placement aspect of the research clinic. The day concluded with a very nice book launch party for the new Handbook of Person-Centred Therapy, where there were speeches and songs and interesting people to talk to.
I still have the other ethics proposal to do, and those three articles, and I haven’t had a chance to talk to Beth about my idea for expediting the meta-analysis, but it’s hard to be pessimistic in the face of all this forward progress. Tomorrow we’re planning to visit the Glasgow’s famous Burrell Collection (I’ve never been), and last night we went to a great concert by an Australian duo named Cloudstreet. Things are pretty intense right now, but it’s great to realize that things really are moving forward, and to be able to balance all the hard work we’re all doing with some fun now and then.
I freaked out this morning: At that moment, although I’d spent most of the past week learning the NRES process and filling out the very long and confusing form, it was still unclear to me how long the University’s research office and ethics committee would take to re-review the Social Anxiety Research Protocol before they would approve it for me to go ahead with the NHS ethics process. In addition, I still have the NRES application for the practice-based recall protocol, which I haven’t started yet. This is holding up three manuscripts that I am supposed to be working on for various people, which were either late or about to be. And the manuscripts are holding up my doing my part of the meta-analysis that Beth is working enthusiastically away at, and that we are supposed to present the results of at three different conferences next month (including the high profile Improving Access to Psychological Therapies conference in London).
Meanwhile, we don’t have any clients yet for either the Social Anxiety study or the Practice-Based Research Protocol study, and we are expecting 4 or 5 students to start seeing clients in the latter protocol within the next month. (And our major source of clients, GP practices, is blocked to us until we get NRES approval, which is probably going take us into January.) ….In addition, the pre-test data collection for part of the diploma course study got messed up and so far we’ve only got about a 30% return rate (vs. 85% for the part-time course). Although I woke up this morning with a feeling of dread, I’d kept this to myself since I got up. Then, as I was about to go out the door with my bike and was saying goodbye to Diane, my tale of woe came pouring out. Then, just as I was winding down (or rather up), I got a phone call from Lorna, who needed me to cover the study groups on the fulltime diploma course for her. I dashed off to work.
In the course of the morning, I visited the diploma course students in the study groups, first getting their finishing time wrong and then having to go back to them and tell them the correct time. I finally faced the fact that I had to do something about the low return rate for the diploma course study. I discovered that the Social Anxiety ethics re-approval process was in danger of going sideways and required immediate intervention to get it back on track. And I discovered that we still hadn’t sorted out the flyer and poster design for the practice-based research protocol.
The low point (and turning point) of the day came when I showed up for the afternoon fulltime large group with a pile of diploma course study forms, hoping to catch some of the nonresponders… only to discover that I had forgotten to photocopy the information and consent forms. I sat there panicking, looking at the students.
Finally, I took a deep breath and tried to explain the situation to them as best I could. It turned out that Julie Folkes-Skinner, the U of Leicester whose dissertation research it is, had confused things by giving the students envelopes with her address for them to return the forms to her directly; however, I had told them to return them to us, as we had done with the part-time course. This led to confusion; some students had put stamps on the envelopes & mailed the forms back to Julie; others had tried to turn them in to the office and been told to mail them themselves (presumably because of the missing stamps) but hadn't because of postal strike, while others just hadn't got around to it or weren’t sure if we are still interested in getting them back. I left them with a plea to do their best to get the forms back to us as soon as possible and to let me know if they were willing to take part in Level II of the study. This at least clarified where the problem was and boded well for salvaging a decent return rate.
I went back to my office, to meet with Isabel on her MSc thesis about the study she is planning on counselling with the dying. Louise at the research office phoned a couple of times and grilled me about aspects of the Social Anxiety study, which began to look like it might get unstuck. Brian and I finalized the Practice-Based Research Protocol, making it more appealing. Beth had given me three important studies that she had analyzed, and somewhere in my wanderings I realized that it might be possible for us to take the meta-analysis to next month’s conferences without us both analyzing all the studies, that we could present a relatively complete set of studies combining our separate analyses, and then later (in December & January) analyze each other’s studies in order to check reliability as we had planned. Then, Lorna announced that she had gotten the cooperation of the Tom Allen Centre to give information about our two protocols to the clients on their long waiting list. Before going home, we had a very productive research committee meerting in which we made significant progress planning how we are going run the student placement aspect of the research clinic. The day concluded with a very nice book launch party for the new Handbook of Person-Centred Therapy, where there were speeches and songs and interesting people to talk to.
I still have the other ethics proposal to do, and those three articles, and I haven’t had a chance to talk to Beth about my idea for expediting the meta-analysis, but it’s hard to be pessimistic in the face of all this forward progress. Tomorrow we’re planning to visit the Glasgow’s famous Burrell Collection (I’ve never been), and last night we went to a great concert by an Australian duo named Cloudstreet. Things are pretty intense right now, but it’s great to realize that things really are moving forward, and to be able to balance all the hard work we’re all doing with some fun now and then.
Saturday, October 06, 2007
Mugdock Wood and Drumclog Moor: The Beginning of the West Highland Way
Entry for 5 Oct 2007:
For this week’s Saturday Adventure, we decided to take a walk on the West Highland Way, and in the process encountered some very interesting local place names and a ruined castle we had never heard of.
Even on Saturday, trains run from Hyndland to Milngavie, which is the beginning of the trail. (By the way, Milngavie is pronounced, “Mull-guy”, and is a confusing transliteration of the Gaelic for David’s Mill.) From there, we blundered about the town centre a bit until we found the trailhead.
The West Highland Way, at this point parallels the Alland Water, a busy stream flowing between often fairly steep banks. The beginning of the trail is not very nice, leading through an abandoned car park, complete with drunk sitting under a porch, then following a path between two walls. Then, an industrial park came into view on the other side of the river, on our left. Soon, however, we left the town behind and the views opened up on either side. Drumclog Moor, full of dying bracken, green and brown, lay on our right, sloping up the hill.
We came to two curved stones set in the path and carved with cursive writing, which we eventually (on the way back) figured out marked the boundary between Drumclog Moor and the Mugdock Wood. (Where do they get these names?; I have been unable to find this out…) We walked on, passing many people out with their dogs, all different kinds of dogs. Mugdock Wood is one of the heritage forests consisting of the original mixed trees, including many old gnarled oaks. It felt peaceful. I entertained myself with fantasies of walking or running the whole trail, which goes all the way to Fort William, 95 miles to the north.
We walked until we reached a road (Kyber Pass, this is called on the trail, an imperial allusion), about 2.5 miles from the beginning of the trail. We turned around and walked back to where we had seen a steep trail going off to the right (now our left), sign-posted for Mugdock Castle. I am a sucker for Scottish castles (of which there is said to be some 3000), so we headed in that direction, up the hill, then along a rather ratty and uneven board walk, and finally up a quite rocky path to the top of the hill.
… Where we found a large ruined castle, with a tall, intact keep and outer wall mostly intact, and the ruins of a large Victorian era mansion, last inhabited in the 1940’s. In 60 years, it had mostly fallen down, so that only the ground floor walls now remain, the rest of having been carted off in the form of rubble. We had no idea that there was castle here, and found ourselves sobered by how quickly it had fallen apart.
There were many people there, out enjoying the pleasant day; a south Asian family was being video-recorded by one their members. Small children ran noisily about, while teenagers climbed on the remaining walls, ignoring the signs warning them not to do so. Various signs indicated to that we had emerged into the middle of Mugdock Country Park, a large parkland which will require much more time to fully explore.
However, we needed to head back before our feet got too sore, so it was back down the hill, past more of stones with flowing, poetic writing set into the path. Back onto the West Highland Way, back through Milngavie, onto the train, and home again, another successful Saturday Adventure concluded.
For this week’s Saturday Adventure, we decided to take a walk on the West Highland Way, and in the process encountered some very interesting local place names and a ruined castle we had never heard of.
Even on Saturday, trains run from Hyndland to Milngavie, which is the beginning of the trail. (By the way, Milngavie is pronounced, “Mull-guy”, and is a confusing transliteration of the Gaelic for David’s Mill.) From there, we blundered about the town centre a bit until we found the trailhead.
The West Highland Way, at this point parallels the Alland Water, a busy stream flowing between often fairly steep banks. The beginning of the trail is not very nice, leading through an abandoned car park, complete with drunk sitting under a porch, then following a path between two walls. Then, an industrial park came into view on the other side of the river, on our left. Soon, however, we left the town behind and the views opened up on either side. Drumclog Moor, full of dying bracken, green and brown, lay on our right, sloping up the hill.
We came to two curved stones set in the path and carved with cursive writing, which we eventually (on the way back) figured out marked the boundary between Drumclog Moor and the Mugdock Wood. (Where do they get these names?; I have been unable to find this out…) We walked on, passing many people out with their dogs, all different kinds of dogs. Mugdock Wood is one of the heritage forests consisting of the original mixed trees, including many old gnarled oaks. It felt peaceful. I entertained myself with fantasies of walking or running the whole trail, which goes all the way to Fort William, 95 miles to the north.
We walked until we reached a road (Kyber Pass, this is called on the trail, an imperial allusion), about 2.5 miles from the beginning of the trail. We turned around and walked back to where we had seen a steep trail going off to the right (now our left), sign-posted for Mugdock Castle. I am a sucker for Scottish castles (of which there is said to be some 3000), so we headed in that direction, up the hill, then along a rather ratty and uneven board walk, and finally up a quite rocky path to the top of the hill.
… Where we found a large ruined castle, with a tall, intact keep and outer wall mostly intact, and the ruins of a large Victorian era mansion, last inhabited in the 1940’s. In 60 years, it had mostly fallen down, so that only the ground floor walls now remain, the rest of having been carted off in the form of rubble. We had no idea that there was castle here, and found ourselves sobered by how quickly it had fallen apart.
There were many people there, out enjoying the pleasant day; a south Asian family was being video-recorded by one their members. Small children ran noisily about, while teenagers climbed on the remaining walls, ignoring the signs warning them not to do so. Various signs indicated to that we had emerged into the middle of Mugdock Country Park, a large parkland which will require much more time to fully explore.
However, we needed to head back before our feet got too sore, so it was back down the hill, past more of stones with flowing, poetic writing set into the path. Back onto the West Highland Way, back through Milngavie, onto the train, and home again, another successful Saturday Adventure concluded.
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