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.
Tuesday, November 27, 2007
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.
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