UKCP Research Conference: Adventures in Practice-Based Research

Entry for 3 February 2008:

On behalf of the UK Council for Psychotherapy (UKCP) Research Committee, my long-standing SPR colleague and fellow conversation analyst, Georgia Lepper invited me to come down to London to speak at their second Research Conference on 2 February. The agreed topic was basically the IPEPPT talk I have been giving in various places for the past couple of years, that is, a presentation on the IPEPPT project, its conceptual framework, and recommended research protocols.

The conference was organized as two keynotes plus small group and plenary discussion, with the goal of promoting their agenda of setting up multiple Practitioner Research Networks (PRNs).

Peter Fonagy was the morning keynote speaker. Before last December’s IAPT conference, I hadn’t seen him since the SPR meeting in Geilo Norway in the mid-1990’s, and now I ran into him again, two months latter. As I had seen before, Peter is an impressive speaker, pulling together different pieces of (attachment) theory and research. Consistent with his general psychodynamic orientation (he is head of the Anna Freud Centre), he puts a great deal of weight on a development perspective and theory. This time, however, he seemed a bit cranky as he used the research evidence criticize commonly-practiced therapies as “abdominal” vs. “keyhole” surgery, potentially producing negative effects, of which therapists are blithely unaware (citing Lambert’s recent signal alarm research).

Losing the plot. I thought that the best part of Peter Fonagy’s talk came in the last few minutes, when he described several key processes in the Mentalization-Based Therapy that he and Tony Bateman have developed for working with clients with Borderline Processes. I’ll deal with his formulation of responding to client anger for a separate blog entry, so I’m just note briefly his lovely take on the therapist difficulty micro-marker of “losing the client’s plot”, i.e., not being able to follow what the client is saying. As Peter noted, a very common response to this is to pretend you understand the client by folding your arms and nodding your head. His interesting observation is that this is in fact a reliable sign that you don't understand (an Incomprehension Marker in PE-EFT terms). Instead, refreshingly, he advocates disclosing to the client that you are having trouble following them. (You do have to be careful how you do this, so as not to leave the client feeling dismissed or inclined to blame themselves for not communicating more clearly, which is why I recommend saying something like, “It might be me, but I’m not sure I’m with you on that. It sounds like it might be important; could you take me through it again?” This is what Laura Rice used to call “empathic nonunderstanding.”)

Change of Plan. While this was interesting, overall content and feel of the talk, plus the ensuing small and plenary group discussion I attended left me feeling that this audience of research-inclined therapists needed something that spoke to them more directly and immediately. Thus, by the time lunch arrived, I had decided to somehow switch talks in the middle, and go over to my HSCED/Bridge Phobia talk, in which I model the process of doing research on my own practice. The only problem was, I couldn’t see how to plug into the sound system, and I hadn’t brought my powered speakers with me.

Encountering Humanistic and Integrative Therapies. However, there more challenges waiting for me at lunch: While waiting in the lunch line, Richard Cleminson identified himself to me as chair of HIPS, the Humanistic and Integrative Psychotherapy Section of UKCP. He expressed concerns about the possibility of Humanistic and Integrative Psychotherapies (and UKCP) being cut out of the process Skills for Health competencies process the Mick, Nancy, Sally and I had begun exploring with Tony Roth and Steve Pilling the previous Tuesday. He also argued that UKCP is the largest body of psychotherapists in the UK (as opposed to “counsellors”), and therefore shouldn’t be left out of the consultation process.

Bad Karma? I had a sinking feeling that I was about to move in the Bad guy column (or already had): In our efforts to stay true to the research evidence -- while also supporting our Person-Centred/Experiential base -- had we really sold out our Humanistic/Integrative colleagues? Mick had told me that the Humanistic/Integrative designation was an obscure, not well-understood construction, but suddenly I was confronted with the existence of a discrete body of humanistic therapists, my erstwhile comrades in therapy, as concerned by our leaving them out, as we were with being left out ourselves. In my book, this is Bad Karma.

Leaving the door open. I heard Richard out, and finally explained to him that I’ve been trying to collect all the quantitative outcome research evidence on humanistic therapies since 1992, trying to be as inclusive as possible. I explained the remit and method the Roth-Pilling process of identifying therapies based on RCT-like studies, manuals (defined broadly), and coherent theory. I said that I felt that this is a fairly broad gate and that to the extent that humanistic-integrative therapies could meet these criteria, there was a good chance they could be included. I then gave him the criteria for candidates for the Expert Reference Group, and asked him to get suggestions for ERG members to me by next week.

Improvised sound system. We were unable to get the sound working for me to play the videos of my client, but I decided to go ahead with the presentation of the case anyway. I drove parts of my audience crazy by flipping through the highlights of my original talk in about 10 minutes before switching over to the case study. I introduced the HSCED method and the client, then I decided they should at least see the client, so I played a bit of the opening to session 1. Someone suggested that I put the microphone up to the speaker, which doesn’t usually work, but did here. So in the end I was able to play the remarkable segment from session 4 where the Unfolding task goes into the client accessing trauma memories and linking his phobia-related panic feelings to his abuse.

Modelling vulnerability. The result was a demanding but I think inspiring talk that illustrated how one can study the process and outcome of one’s own work as a therapist. Someone noted that I had made myself vulnerable, and indeed I did feel nervous presenting this client to a largely psychodynamic audience. The last time I had done so, someone opined that I was potentially re-traumatizing my client, and indeed this time, I was subsequently characterized as (a) deliberately using hypnosis with this client; (b) has having led my client to my interpretation that his panic symptoms were linked to his childhood abuse; and (c) having missed an opportunity to help the client consolidate his insight by explicitly interpreting the link to him.

PE-EFT as an integrative humanistic therapy. But the most interesting unintended consequence of playing the video was that Richard Cleminson came up to me afterwards to tell me that he considered what I had played as a clear example of what he and his section of UKCP mean by Integrative Humanistic therapy. I said I had no problem with that and looked forward to hearing from him.

In fact, Richard is correct: PE-EFT certainly is an integrative humanistic therapy (it even says so on our website!). But it’s also person-centred therapy (broadly if not Brodley). This makes it a natural bridge between the more classical or traditional Person-Centred therapy and much of the rest of the humanistic therapy family. I’m not sure what to do yet about the humanistic therapies that are further out, like bioenergetics, transpersonal therapy or the various energy therapie, but the absence of research evidence on outcome means that we don’t have to answer this question yet. Now the integrative humanistic therapies have to decide what to do: to stand with PE-EFT or do their own outcome research. This smartest thing would be for them to do both! But in any case, once again, it’s clear that psychotherapy/ counselling is a small community of overlapping, competing interest groups, and that the weave among them just keeps getting richer and more complex.