Entry for 29 July 2008:
Revised Presentation/Lecture notes, Day 2 RDI Training the Trainers Summer School on Counselling Research Methods, Leicester, UK, July 2008.
I. Systematic Single Case Studies at Diploma level
1. Convert standard case study requirement into systematic case study
2. Importance of having an example: Find an interesting case that has been studied systematically (e.g., Elliott, 2002; journal: Pragmatic Case Studies in Psychotherapy)
3. Needs support and guidance (Stinckens, Elliott & Leijssen, in press)
4. Systematic case studies can vary enormously in complexity, e.g.,
•Pragmatic Case Study (D. Fishman)
•Legalistic/Adjudicated case study (A. Bohart, R. Miller)
•Hermeneutic Single Case Efficacy Design (HSCED; R. Elliott)
•Uses version of IPEPPT Systematic Case Study Research Protocol
•See: Elliott (2002) Psychotherapy Research
II. General Principles of Systematic Case Studies:
A. Three Key Questions in systematic case studies:
1. Did my client change substantially over the course of counselling?
2. If the client changed, did counselling make a substantial contribution?
3. If the client changed, what brought about those changes?
B. Research Steps
1. Assemble a rich case record:
•Multiple data sources, qualitative/ quantitative
2. Outcome analysis; Analyze and interpret outcome data
3. Change process analysis: Organize and interpret evidence that counselling contributed to client change (include how counselling helped)
4. Critical reflection: Critically evaluate alternative explanations
III. Systematic Case Study Methods
A. Assemble Rich Case Record:
1. Basic descriptive information (demographics, diagnoses, problems, therapy approach)
2. Quantitative outcome measures: one or more (preferably related to theoretical model or client issues)
3. Weekly or fortnightly outcome measure (e.g., Personal Questionnaire or CORE-10)
4. Change Interview (qualitative; can be done by counsellor but better someone else; e.g., students help each other)
5. Helpful Aspects of Therapy (HAT) form (client; significant events)
6. Records of counselling sessions (tapes, therapist process notes)
B. Outcome analysis:
•Weekly change measure & one other
1. Make table showing:
•Clinical cut-off level (“caseness”) (e.g., CORE-OM: 1.25)
•Reliable change minimum value (CORE-OM: .5)
•Client pre-counselling value
•Client post-counselling value
•Indicate which values are (a) above caseness, and (b) show reliable improvement or deterioration
2. Make graph showing weekly outcome measure scores
C. Evaluating Therapeutic Influence: Change Process Analysis
•Looking for evidence of connections between what happened in counselling and outcome:
•Types of Evidence:
1. Change Interview (ratings of changes; attribution question; helpful aspects)
2. HAT descriptions of significant events (Helpfulness: 7+)
3. Sudden gains within therapy (big changes from one week to the next)
4. Changes in stable problems: Quantitative/qualitative changes from pre to post, plus information about how long client has had problem
D. Critical Reflection
•Make good-faith effort to find evidence that client didn’t change and that if they did, it had nothing to do with the counselling
1. Non-change explanations:
•Nonimprovement (trivial amount change, or gets worse)
•Relational artifacts: tries to convince therapist, research team (“hello goodbye” effect)
•Expectancy artifacts: self-deception (cultural or personal “scripts” about therapy)
2. Non-therapy explanations:
•Self-help (efforts separate from therapy)
•Extra-therapy events
•Psychobiological causes (medication or recovery from injury or illness)
•Reactive effects of research (research activities, altruism) [Construct validity]
IV. Example of Systematic Case Study “George”
A. Description of Client
1. Demographic information 61 year-old European-American male; married; some college; retired; former security administrator
2. Psychosocial History: emotional and physical abuse; suicide attempt as teenager (drove car into quarry); estranged from 2 of 3 children; wants to move to SW United States; frustrated that wife won’t.
3. Presenting Problems and Diagnosis
•Presenting problem: Panic attacks; primarily on expressway (4 yrs)
•Fear of heights, boating, and excessive speed
•Interpersonal difficulties due to “abrasive personality”
•Main goal = to cross bridges
4. DSM-IV Diagnosis:
•Axis I [based on SCID]: Panic Disorder w/ Agoraphobia; also Specific Phobia
•Past problems: Major Depressive Disorder, In Full Remission; Alcohol Dependence, Sustained Full Remission
•Axis II: None (but features)
B. Description of Therapy
1. 23 sessions: Client terminated by own choice; regarded treatment as successful
2. Process-Experiential/Emotion-Focused therapy: integration of Person-Centered & Gestalt therapies
3. Center for the Study of Experiential Psychotherapy (University of Toledo)
4. Therapist – 50 yrs. old; experienced PE-EFT therapist; one of originators of approach
C. Outcome Analysis
1. Quantitative Outcome Data:
a. Instrument: SCL-90-R GSI
Caseness cut-off: .93
RCI (p < .2): .51
Pre-Tx: .77
Post-10: .56
Post-Tx: .57
b. Instrument: Inventory of Interpersonal Problems
Caseness cut-off: 1.50
RCI (p < .2): .57
Pre-Tx: 1.96 (=clinical range)
Post-10: 1.46
Post-Tx: 2.27 (=clinical range)
c. Instrument: Personal Questionnaire
Caseness cut-off: 3.00
RCI (p < .2): .53
Pre-Tx: 4.33 (=clinical range)
Post-10: 5.33 (=clinical range; reliable deterioration)
Post-Tx: 4.83 (=clinical range)
d. Weekly Outcome on Personal Questionnaire: Varies erratically throughout therapy, between 4.3 (=Moderately distressing) and 5.8 (Very Considerably distressing)
2. Qualitative Outcome data (Change Interview):
•Can cross bridges now
•Better relationship with wife
•More tolerant
•Less afraid of flying
D. Change Process Analysis:
1. George’s Post-Therapy Account of What Helped Him
•Very general, focused on therapeutic relationship:
•Emphasized nature of relationship with T: T is “a good man”; interactions as pleasant, harmonious; T did not intrude past C’s personal boundaries, but expressed personal pleasure in C’s progress
•T helped C develop a new, broader, more tolerant perspective on others, life.
Conclusion: George describes helpful aspects of therapy, attributes some of his changes to therapy (“would not have happened without therapy”).
2. George’s Highest-Rated Significant Therapy Events (HAT):
•Session 4, extremely helpful (“9”): “When (therapist) mentioned that my childhood experiences could have a direct bearing on my problems now. Never thought of it as having anything to with my fear of bridges…”
•Session 6, extremely helpful: “The part where I talked to my daughter [empty-chair work]. Found out she is one of the bridges I cannot or at least have not tried to cross.”
George’s Highest-Rated Significant Therapy Events - 3
•Session 9, extremely helpful: “When (therapist) told me to confront my mother [empty-chair work] and tell her how disappointed I was and still am with her. Never did this when she was alive. Should have. It was a relief.”
•Session 11, extremely helpful: “Discovery of my deep-seated anger. I never knew how much anger could influence how I feel about almost everything I encounter in life.”
•Session 16, greatly helpful: “I found out that before I tackle a problem, I stop breathing. Upon facing the problem of crossing a bridge I made an effort to breathe clear across the bridge and it worked.”
Conclusion: George’s significant events, as described on the HAT form, are in the clinically significant range (Helpfulness: >7); some are also directly connected to posttherapy changes (Sessions 4, 11, 16)
3. Sudden Gains: George’s PQ scores remained high but erratic throughout therapy, showing no sustained improvements, sudden or not.
Conclusion: No evidence for therapy bringing about change here.
4. Change in stable problems:
a. Change: Can cross bridges now
•Corresponding Problem: Fear of expressway/ heights/ speed [=Bridges]
•Duration: 4 years
b. Change: Better relationship with wife
•Corresponding Problem: Problems with relatives/ Abrasive
•Duration: ??
c. Change: More tolerant
•Corresponding Problem: Problems with relatives/ Abrasive
•Duration: Long-standing
d. Change: Less afraid of flying
•Corresponding Problem: Fear of flying
•Duration: ??
Conclusion: The George showed change on at least some of his stable problems .
D. Critical Reflection:
1. Non-Change Explanations:
•Did not improve on any of the quantitative measures from pre- to posttreatment (small increases on IIP, PQ!)
•Qualitative reported changes not supported by quantitative data
•Spontaneous remarks: “I’ll talk to that nice young lady any time!”
•Discrepant data suggest possibilityof self-deception by client
2. Non-therapy explanations:
•In vivo exposure: George reported stable changes in ability to fly and cross bridges only after he flew to Florida and drove across 90 miles of bridges.
•Recent trip: in vivo exposure; Wife’s changed behavior; recurrence of daughter’s cancer
•Research intensive protocol (repeated use of questionnaires, interviews); research staff repeatedly questioned client about changes
E. Case Update:
1. 6-month Follow-up
•Client maintained ability to cross bridges; still describes himself as “abrasive”
•Recollected helpful aspects of therapy: Therapist is a “truly good man”; therapist actually cared; therapist never actually told client that he COULD cross bridges
•Client requested additional therapy to deal with interpersonal difficulties, bhut heart by-pass surgery prevented
2. 18-month follow-up:
•Able to drive across bridges at least half the time; still attributes this to his therapy
•“People tell me I’m a nicer person.”; attributes this to illnesses
3. Follow-up Outcome Data: Reliable improvement on Personal Questionnaire (6- and 18-month follow-ups)
Thursday, July 31, 2008
Wednesday, July 30, 2008
RDI Training the Trainers Summer School
Entry for 29 July 2008:
After months of planning our ESRC Researcher Development Initiative-funded week-long Summer School, at the University of Leicester, got underway this week. After staying up to 4am working getting the meta-analysis data set into shape in preparation for our month away in the US, I took the train down on Sunday afternoon. After the usual Sunday train delays (they are working on the West Coast Line through the Lake District so we got stuck on a bus between Carlisle and Lancaster), I arrived in Leicester about 7pm. Sue Wheeler picked me up from my hotel about half an hour later, and whisked me off to a classic english country pub. Summer had come, belatedly and all too brief to the UK, and it was a lovely warm evening, so we dined alfresco in the garden behind the pub, where we talked on as night fell.
Roman Ruins in Leicester. When Diane and visited Leicester last Autumn, we heard that there were a Roman Ruin near Vaughan College, the site of the Summer School. However, I was startled to discover that the college actually overlooks and is built around a major Roman historical site: the foundations of a large Roman bath complex, the social centre of the ancient Roman city, with a section of wall towering over the foundations. Underneath where the college is today were the furnaces that heated the whole thing, with a run of large hot baths, then a series of less hot baths stretching to the wall, which is marked by two large entrances that connected the baths to the gymnasium, which lies under the Church of St. Nicholas. The ground floor of the college, like the foundations of the ancient baths, is below street level; there is substantially-sized museum there describing life and Roman times and earlier. I was particularly taken by the half-size figures of the inhabitants, from Mesolithic (middle stone age) to Roman times, dressed in period clothing, which started out as rudimentary furred animal skins, and evolved through tanned leather (Neolithic) to increasingly sophisticated woven cloth (bronze age and later).
I didn’t have too much time to absorb this, because the two days kept me quite busy preparing, presenting and interacting with the 25 counselling trainers who were present. They represented a wide variety of theoretical orientations (a pleasant and stimulating variation on the mostly person-centred audiences I’m used to), counselling modalities, types of training course, personalities, etc.
I was helping Sue and Kaye Richards cover the first two (of 5) days. Sue and Kaye led off with an introduction to the week and the project. I did my Setting up Outcome-Process Monitoring/Introduction to Quantitative Research presentation, which I have presented enough times that it now works pretty well. The trainers really liked the format; and that really pleased me.
Multiple Training Needs. However, we immediately ran into a fundamental contradiction about the RDI project: Our grant is supposed to focus on training them in how to teach research more effectively, but the trainers themselves are hungry for more research training. As a result they kept wanting to move to the PhD level of discussion rather than the diploma (and masters) levels. This led to very interesting and challenging discussions, which periodically had to be directed back to the Matter at Hand. But really, much more is needed.
Qualitative Evaluation and Systematic Case Studies. The second day (today) turned out to more challenging for me, because I had two different inputs, both less honed than the Outcome Monitoring one. I stayed up until 2am completely revising both of them (including parallel Powerpoint and Word lecture note formats, as is my practice). In the end, the morning session on Qualitative Evaluation methods turned out quite well, but the temptation to pick my brains about a variety of qualitative research methods topics proved to be irresistible for the audience, so we spent quite a bit of time on that.
By this afternoon they had all the pieces they needed for Systematic Case Studies a la Robert/HSCED. I had made a valiant attempt to simplify HSCED (Hermeneutic Single Case Efficacy Design) to something approximating the diploma level; however, I did not entirely succeed: it became clear that this was way too complicated for the target audience, and many of the trainers struggled in places. As a result, I’ve spent a good part of this trip home revising the presentation while it is still fresh in my mind. I’m posting a version of the revised lecture notes as an entry on this blog.
Simplifying HSCED: The key is cut enough complicated bits to make it digestible, while still retaining enough of systematicness to make it worth doing. In the end, I think that it is a process of successive approximations from diploma through masters to PhD levels. At the diploma level, only one or two quantitative measures are used; the Affirmative and Skeptic processes and specific arguments are dropped in favour of a less systematic use of the data. The assembly and presentation of the rich case record is emphasized. And so on.
At the end of the day, before Sue whisked me away to the train station for the journey home, it became clear that these first two days had largely succeeded. There was a satisfying round of applause for how far we’d come. I’ve also been very impressed by Sue’s organizational skills (she runs a huge number of different counselling skills courses), and her skill as a trainer. She always seemed to know just when it was time for the participants to stop and break up into small groups of two, three, or 10 to discuss their process, needs, goals, plans etc. I really appreciated her sensitivity to the group process and her flexibility. John McLeod arrived tonight to continue the Research Methods Relay Race through the week. I’m not sure I could have handled more than the two days, but it was certainly intense, fun and productive.
Summer Research Workshops? In the course of the past two days it has become totally evident that there is a huge need and appetite for more training in research methods for these counselling trainers. I think what is needed is a series of summer research workshops modelled on the Clarion and other Writers’ Workshops that over the past 20 years have been so successful in nurturing new generations of science fiction writers. Counselling, like science fiction, is a marginalized discipline, regarded by mainstream academics as not particularly respectable. The solution called for is an alternate structure to provide support and nurturance to help early and even mid-level practitioners develop skills and identify opportunities. If we don't support and nurture ourselves, no one else is really going to be there to do it for us! And this has been a start.
After months of planning our ESRC Researcher Development Initiative-funded week-long Summer School, at the University of Leicester, got underway this week. After staying up to 4am working getting the meta-analysis data set into shape in preparation for our month away in the US, I took the train down on Sunday afternoon. After the usual Sunday train delays (they are working on the West Coast Line through the Lake District so we got stuck on a bus between Carlisle and Lancaster), I arrived in Leicester about 7pm. Sue Wheeler picked me up from my hotel about half an hour later, and whisked me off to a classic english country pub. Summer had come, belatedly and all too brief to the UK, and it was a lovely warm evening, so we dined alfresco in the garden behind the pub, where we talked on as night fell.
Roman Ruins in Leicester. When Diane and visited Leicester last Autumn, we heard that there were a Roman Ruin near Vaughan College, the site of the Summer School. However, I was startled to discover that the college actually overlooks and is built around a major Roman historical site: the foundations of a large Roman bath complex, the social centre of the ancient Roman city, with a section of wall towering over the foundations. Underneath where the college is today were the furnaces that heated the whole thing, with a run of large hot baths, then a series of less hot baths stretching to the wall, which is marked by two large entrances that connected the baths to the gymnasium, which lies under the Church of St. Nicholas. The ground floor of the college, like the foundations of the ancient baths, is below street level; there is substantially-sized museum there describing life and Roman times and earlier. I was particularly taken by the half-size figures of the inhabitants, from Mesolithic (middle stone age) to Roman times, dressed in period clothing, which started out as rudimentary furred animal skins, and evolved through tanned leather (Neolithic) to increasingly sophisticated woven cloth (bronze age and later).
I didn’t have too much time to absorb this, because the two days kept me quite busy preparing, presenting and interacting with the 25 counselling trainers who were present. They represented a wide variety of theoretical orientations (a pleasant and stimulating variation on the mostly person-centred audiences I’m used to), counselling modalities, types of training course, personalities, etc.
I was helping Sue and Kaye Richards cover the first two (of 5) days. Sue and Kaye led off with an introduction to the week and the project. I did my Setting up Outcome-Process Monitoring/Introduction to Quantitative Research presentation, which I have presented enough times that it now works pretty well. The trainers really liked the format; and that really pleased me.
Multiple Training Needs. However, we immediately ran into a fundamental contradiction about the RDI project: Our grant is supposed to focus on training them in how to teach research more effectively, but the trainers themselves are hungry for more research training. As a result they kept wanting to move to the PhD level of discussion rather than the diploma (and masters) levels. This led to very interesting and challenging discussions, which periodically had to be directed back to the Matter at Hand. But really, much more is needed.
Qualitative Evaluation and Systematic Case Studies. The second day (today) turned out to more challenging for me, because I had two different inputs, both less honed than the Outcome Monitoring one. I stayed up until 2am completely revising both of them (including parallel Powerpoint and Word lecture note formats, as is my practice). In the end, the morning session on Qualitative Evaluation methods turned out quite well, but the temptation to pick my brains about a variety of qualitative research methods topics proved to be irresistible for the audience, so we spent quite a bit of time on that.
By this afternoon they had all the pieces they needed for Systematic Case Studies a la Robert/HSCED. I had made a valiant attempt to simplify HSCED (Hermeneutic Single Case Efficacy Design) to something approximating the diploma level; however, I did not entirely succeed: it became clear that this was way too complicated for the target audience, and many of the trainers struggled in places. As a result, I’ve spent a good part of this trip home revising the presentation while it is still fresh in my mind. I’m posting a version of the revised lecture notes as an entry on this blog.
Simplifying HSCED: The key is cut enough complicated bits to make it digestible, while still retaining enough of systematicness to make it worth doing. In the end, I think that it is a process of successive approximations from diploma through masters to PhD levels. At the diploma level, only one or two quantitative measures are used; the Affirmative and Skeptic processes and specific arguments are dropped in favour of a less systematic use of the data. The assembly and presentation of the rich case record is emphasized. And so on.
At the end of the day, before Sue whisked me away to the train station for the journey home, it became clear that these first two days had largely succeeded. There was a satisfying round of applause for how far we’d come. I’ve also been very impressed by Sue’s organizational skills (she runs a huge number of different counselling skills courses), and her skill as a trainer. She always seemed to know just when it was time for the participants to stop and break up into small groups of two, three, or 10 to discuss their process, needs, goals, plans etc. I really appreciated her sensitivity to the group process and her flexibility. John McLeod arrived tonight to continue the Research Methods Relay Race through the week. I’m not sure I could have handled more than the two days, but it was certainly intense, fun and productive.
Summer Research Workshops? In the course of the past two days it has become totally evident that there is a huge need and appetite for more training in research methods for these counselling trainers. I think what is needed is a series of summer research workshops modelled on the Clarion and other Writers’ Workshops that over the past 20 years have been so successful in nurturing new generations of science fiction writers. Counselling, like science fiction, is a marginalized discipline, regarded by mainstream academics as not particularly respectable. The solution called for is an alternate structure to provide support and nurturance to help early and even mid-level practitioners develop skills and identify opportunities. If we don't support and nurture ourselves, no one else is really going to be there to do it for us! And this has been a start.
Tuesday, July 29, 2008
On Pre-Post Effect Size Statistics
Entry for 27 July 2008:
Jess Owen, of Gannon University, has written to the SPR list server with an interesting question:
First, in narrow statistical terms, it depends on what kind of significance test was used: If the client pre-post scores aren’t paired, then an independent samples t-test is used to detect whether the difference is statistically significant, and one divides the difference of pre- and post test by the pooled standard deviation (the geometric mean of pre and post standard deviations). This is the situation that Jess Owen is referring to. However, where pre-post client scores can be paired, a more powerful statistical test is available: the dependent t-test, which takes advantage of the pre-post (or test-retest) correlation to reduce error – a long as the pre-post correlation is .5 or higher. In meta-analysis, the pre-post correlation is generally not available, so one has to resort to rules of thumb estimation procedures (e.g., Smith, Glass & Miller, 1980; if it’s a standardized inventory measure given at a 4-month interval, assume r = .5). I personally don’t like having to use these estimation procedures, which is one reason why I don’t use effect sizes based on dependent t-tests.
Second, methodologically, it depends on how you are thinking of the pre-test. For example, I like to conceptualize the pre-test as representing the population of clients not in therapy, while the post-test represents the population of clients who have had therapy. This is the logic of talking about therapy from the point of view helping client moving from one population to another, e.g., the average client moves from the 50th to the 85th percentile of the untreated population, which is another way of saying that they improved by about one standard deviation unit. In this way, also, it makes sense to use the straightforward standardized different metric described above.
Third, substantively, it appears that uncontrolled pre-post effect sizes do tend to run larger than controlled effects between the post test scores of treated and untreated clients. Lipsey and Wilson (1993) reported this in their meta-meta-analysis. However, it’s never been clear to me how much their results reflect the use of the ESs based on dependent t-tests, or whether pre-post effects are just bigger than controlled post-only effects. Fortunately, it turns out that I can use the person-centred/experiential (PCE) therapy meta-analysis results to shed some light on this question: In this data set, clients seen in PCE therapy change about 1.0 sd (=a very large effect), while control participants change about .2 sd (a small effect); as a result, the controlled standardized gain statistic (i.e., the difference between treated and untreated participants) is about .8 sd (a large effect). In other words, the pre-post ES is a wee bit bigger than the controlled ES, and this is important to be aware of. This is of course why no-treatment control designs are used in first place, but the data show that in general such controls don’t do much except make our studies look more scientific. However, there are always exceptions; for example, some types of clients probably improve on their own more than .2 sd, while untreated distressed couples may get worse!
As a result of all three of these considerations, I prefer to use a simple standardized difference as a basic effect size for therapy outcome research: It’s more conservative (generally) than an effect size based on the dependent t-test; it’s easier to think about in population terms; and it’s closer rather than further away from a controlled ES. A final note: Psychotherapy is a wonderful thing, and perfectly capable of producing extremely large effects, including one on the order of 2 or 3 sd or even larger!
Lipsey, M.W., & Wilson, D.B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48, 1181-1209.
Smith, M.L., Glass, G.V., & Miller, T.I. (1980). The benefits of psychotherapy. Baltimore: The Johns Hopkins University Press.
Jess Owen, of Gannon University, has written to the SPR list server with an interesting question:
I was wondering if anyone had a good reference or just general thoughts for adjusting the effect size for single group pre-post study?This question has statistical, design, and substantive implications.
Currently, I have found a consistent theme in the literature to use the pre-SD in the equation. However, even with the pre-SD, I am finding some pretty large effect sizes (e.g., > 2). I would like to think that the intervention made a big difference, but I am better sure that this is inflated given the use of only an experimental group.
First, in narrow statistical terms, it depends on what kind of significance test was used: If the client pre-post scores aren’t paired, then an independent samples t-test is used to detect whether the difference is statistically significant, and one divides the difference of pre- and post test by the pooled standard deviation (the geometric mean of pre and post standard deviations). This is the situation that Jess Owen is referring to. However, where pre-post client scores can be paired, a more powerful statistical test is available: the dependent t-test, which takes advantage of the pre-post (or test-retest) correlation to reduce error – a long as the pre-post correlation is .5 or higher. In meta-analysis, the pre-post correlation is generally not available, so one has to resort to rules of thumb estimation procedures (e.g., Smith, Glass & Miller, 1980; if it’s a standardized inventory measure given at a 4-month interval, assume r = .5). I personally don’t like having to use these estimation procedures, which is one reason why I don’t use effect sizes based on dependent t-tests.
Second, methodologically, it depends on how you are thinking of the pre-test. For example, I like to conceptualize the pre-test as representing the population of clients not in therapy, while the post-test represents the population of clients who have had therapy. This is the logic of talking about therapy from the point of view helping client moving from one population to another, e.g., the average client moves from the 50th to the 85th percentile of the untreated population, which is another way of saying that they improved by about one standard deviation unit. In this way, also, it makes sense to use the straightforward standardized different metric described above.
Third, substantively, it appears that uncontrolled pre-post effect sizes do tend to run larger than controlled effects between the post test scores of treated and untreated clients. Lipsey and Wilson (1993) reported this in their meta-meta-analysis. However, it’s never been clear to me how much their results reflect the use of the ESs based on dependent t-tests, or whether pre-post effects are just bigger than controlled post-only effects. Fortunately, it turns out that I can use the person-centred/experiential (PCE) therapy meta-analysis results to shed some light on this question: In this data set, clients seen in PCE therapy change about 1.0 sd (=a very large effect), while control participants change about .2 sd (a small effect); as a result, the controlled standardized gain statistic (i.e., the difference between treated and untreated participants) is about .8 sd (a large effect). In other words, the pre-post ES is a wee bit bigger than the controlled ES, and this is important to be aware of. This is of course why no-treatment control designs are used in first place, but the data show that in general such controls don’t do much except make our studies look more scientific. However, there are always exceptions; for example, some types of clients probably improve on their own more than .2 sd, while untreated distressed couples may get worse!
As a result of all three of these considerations, I prefer to use a simple standardized difference as a basic effect size for therapy outcome research: It’s more conservative (generally) than an effect size based on the dependent t-test; it’s easier to think about in population terms; and it’s closer rather than further away from a controlled ES. A final note: Psychotherapy is a wonderful thing, and perfectly capable of producing extremely large effects, including one on the order of 2 or 3 sd or even larger!
Lipsey, M.W., & Wilson, D.B. (1993). The efficacy of psychological, educational, and behavioral treatment: Confirmation from meta-analysis. American Psychologist, 48, 1181-1209.
Smith, M.L., Glass, G.V., & Miller, T.I. (1980). The benefits of psychotherapy. Baltimore: The Johns Hopkins University Press.
Monday, July 21, 2008
Bothwell Castle and the David Livingston Centre
Entry for 19 July 2008:
We’ve been continuing to keep up our custom of Saturday Adventures whenever we’re in town. Last Saturday, for example, we visited the Museum of Scotland in Edinburgh, spending almost the whole time in the basement looking at old stuff: neolithic, bronze age, and Roman, with a smattering of early Christian artefacts.
For this week’s adventure, after a bit of research, we determined that we could easily visit Bothwell Castle by taking the train to Uddingston and walking about a mile from the train station. It was raining when we arrived (the weather has been most un-summerlike for the past couple of weeks), and our feet quickly got wet as we trekked down to the castle, but it stopped after a bit and by the time we arrived bits of blue sky were showing. Although it’s a ruin, Bothwell Castle towers imposingly on a bend in the River Clyde, red sandstone, cut from the same rock as the stone that clads Glasgow’s famous red sandstone tenement flats, like the one we live in. Unlike many of the castles we’ve visited, however, this one saw plenty of action in its time, changing hands repeatedly in the wars between England and Scotland in early 14th century. We have the castle visit thing down to an art by now: scope out the great hall & chapel, kitchen, buy a guidebook, talk to the guide, climb up and down the tower(s), etc. The old keep, or donjon, where the lord originally lived, is particularly impressive, even with only half of it remaining.
The guide recommended that we hike up the river a mile to the David Livingston Centre, which I’d seen written up in our Scottish Heritage book, but hadn’t quite put together with Bothwell Castle. It turned out to be a lovely afternoon for a walk up the River Clyde’s leafy banks, in and out of shade, cloud and sun, until we reached the large, sturdy foot-bridge between Bothwell and Blantyre. There, in the middle of Lanarkshire, in the old cotton mill town of Blantyre, is a museum and park dedicated to celebrating the life of the Scottish medical missionary, African adventurer, and 19th century abolitionist. I found him to be an inspiring example of living by one’s values and ideals.
We caught the train from Blantyre and were back in time for Kenneth’s 4pm dugeon & dragons sessions with his friends in Ohio. As with the Museum of Scotland the week before, we are likely to return to both of today’s destinations, and we have explored another little bit of the Glasgow area, backwards and forwards in time and space, like Dr Who's TARDIS, making the unfamiliar familiar, finding our way into a life here.
We’ve been continuing to keep up our custom of Saturday Adventures whenever we’re in town. Last Saturday, for example, we visited the Museum of Scotland in Edinburgh, spending almost the whole time in the basement looking at old stuff: neolithic, bronze age, and Roman, with a smattering of early Christian artefacts.
For this week’s adventure, after a bit of research, we determined that we could easily visit Bothwell Castle by taking the train to Uddingston and walking about a mile from the train station. It was raining when we arrived (the weather has been most un-summerlike for the past couple of weeks), and our feet quickly got wet as we trekked down to the castle, but it stopped after a bit and by the time we arrived bits of blue sky were showing. Although it’s a ruin, Bothwell Castle towers imposingly on a bend in the River Clyde, red sandstone, cut from the same rock as the stone that clads Glasgow’s famous red sandstone tenement flats, like the one we live in. Unlike many of the castles we’ve visited, however, this one saw plenty of action in its time, changing hands repeatedly in the wars between England and Scotland in early 14th century. We have the castle visit thing down to an art by now: scope out the great hall & chapel, kitchen, buy a guidebook, talk to the guide, climb up and down the tower(s), etc. The old keep, or donjon, where the lord originally lived, is particularly impressive, even with only half of it remaining.
The guide recommended that we hike up the river a mile to the David Livingston Centre, which I’d seen written up in our Scottish Heritage book, but hadn’t quite put together with Bothwell Castle. It turned out to be a lovely afternoon for a walk up the River Clyde’s leafy banks, in and out of shade, cloud and sun, until we reached the large, sturdy foot-bridge between Bothwell and Blantyre. There, in the middle of Lanarkshire, in the old cotton mill town of Blantyre, is a museum and park dedicated to celebrating the life of the Scottish medical missionary, African adventurer, and 19th century abolitionist. I found him to be an inspiring example of living by one’s values and ideals.
We caught the train from Blantyre and were back in time for Kenneth’s 4pm dugeon & dragons sessions with his friends in Ohio. As with the Museum of Scotland the week before, we are likely to return to both of today’s destinations, and we have explored another little bit of the Glasgow area, backwards and forwards in time and space, like Dr Who's TARDIS, making the unfamiliar familiar, finding our way into a life here.
Friday, July 18, 2008
Leijssen & Elliott (2008). Integrative experiential psychotherapy in brief
This is an article that Mia and I had fun doing together. Actually, we started by getting a very nice dutch-language paper of hers translated into English. I always enjoy the clarity and groundedness of her writing, and I always learn something from her. So I kept including more and more bits of her work, and pretty soon, it ended up with so much of her work in it that she really needed to be first author, which I had no trouble with. Keith Tudor found it a bit strange that our example client had received 25 sessions of “short-term” therapy, because that didn’t seem very short to him, but it was pretty clear to me that this client covered a lot of ground in a relatively brief period of time, so that it was almost like 4 brief therapies, one right after another. One the things I learned from Mia in this paper was the idea/practice of the therapist offering to keep the client’s pain between sessions. I’ve since tried this with my clients in the Social Anxiety project, to good effect.
Reference: Leijssen, M., & Elliott, R. (2008). Integrative experiential psychotherapy in brief. In K. Tudor (Ed.), Brief Person-Centred Therapies (pp. 31-46). London: Sage.
Abstract. Contemporary experiential therapies integrate aspects of several different suborientations within the broad client-centered/experiential approach, with new theory, practice and research, supporting their use as brief treatments. In this chapter we provide an overview of some of the main elements of current experiential therapy, with special reference to its application as a brief therapy. We briefly summarize the main research data supporting the effectiveness of this approach, We work in a more orthodox client-centered way to facilitate the narrative construction of the client’s life. We also introduce focusing micro-processes to help the client develop a healthy internal self-relationship. Interpersonal work takes the lead when maladaptive interpersonal schemes are hindering the relational life of the client. In addition, we appreciate existential processes, especially when the client struggles with the givens of life. In this chapter, we offer several vignettes from a short-term psychotherapy to illustrate this integrative approach. The client in this case study reported the introduction of a time-limit at the start of the therapy as stimulating and hopeful.
Reference: Leijssen, M., & Elliott, R. (2008). Integrative experiential psychotherapy in brief. In K. Tudor (Ed.), Brief Person-Centred Therapies (pp. 31-46). London: Sage.
Abstract. Contemporary experiential therapies integrate aspects of several different suborientations within the broad client-centered/experiential approach, with new theory, practice and research, supporting their use as brief treatments. In this chapter we provide an overview of some of the main elements of current experiential therapy, with special reference to its application as a brief therapy. We briefly summarize the main research data supporting the effectiveness of this approach, We work in a more orthodox client-centered way to facilitate the narrative construction of the client’s life. We also introduce focusing micro-processes to help the client develop a healthy internal self-relationship. Interpersonal work takes the lead when maladaptive interpersonal schemes are hindering the relational life of the client. In addition, we appreciate existential processes, especially when the client struggles with the givens of life. In this chapter, we offer several vignettes from a short-term psychotherapy to illustrate this integrative approach. The client in this case study reported the introduction of a time-limit at the start of the therapy as stimulating and hopeful.
Tuesday, July 15, 2008
Emotion-Focused Therapy: Level 3 Supervision Series 2008-09
Facilitated by Robert Elliott
Professor of Counselling, University of Strathclyde
Tuesdays, 6-9pm, 9 September, 2008 – 9 June, 2009
Sir Henry Wood Building
Jordanhill Campus
University Of Strathclyde
(Sponsored by the Professional Development Unit, University of Strathclyde)
The Counselling Unit at the University of Strathclyde are pleased to offer continuing training in Emotion-Focused Therapy (EFT) for counsellors and psychotherapists (Diploma level or above) who have completed Level Two training in EFT. This 12-session series will meet every three or four weeks throughout the 2008-09 academic year, beginning in September. The format will primarily focus on supervision of recorded therapy sessions, supplemented as appropriate by viewing of archival video-recordings, brief lectures, experiential practice exercises in small groups, and discussion. Emphasis will be on putting EFT into practice and examining blocks to effective practice.
This series is scheduled for the following dates. Sessions will take place in Wood W614, except where otherwise indicated:
Autumn 2008:
9 September
7 October
28 October in W500
18 November in W502
16 December
Winter-Spring 2008:
20 January
17 February
17 March
7 April
28 April
19 May
9 June
• Enrolment is set for a maximum of 12.
• Tentative Course fee: Until 15 August: £345; after 15 August: £395.
• The course could be taken for continuing professional education credit.
Professional Development Unit applications may be downloaded at http://www.strath.ac.uk/Departments/PDU/shortcourses/shortcourses.html (Note that that this course is not on the official list.)
Please direct enquiries to the PDU office (0141 950 3734) or Robert Elliott (Robert.Elliott@strath.ac.uk or fac0029@gmail.com ).
(version 15 July 2008)
Professor of Counselling, University of Strathclyde
Tuesdays, 6-9pm, 9 September, 2008 – 9 June, 2009
Sir Henry Wood Building
Jordanhill Campus
University Of Strathclyde
(Sponsored by the Professional Development Unit, University of Strathclyde)
The Counselling Unit at the University of Strathclyde are pleased to offer continuing training in Emotion-Focused Therapy (EFT) for counsellors and psychotherapists (Diploma level or above) who have completed Level Two training in EFT. This 12-session series will meet every three or four weeks throughout the 2008-09 academic year, beginning in September. The format will primarily focus on supervision of recorded therapy sessions, supplemented as appropriate by viewing of archival video-recordings, brief lectures, experiential practice exercises in small groups, and discussion. Emphasis will be on putting EFT into practice and examining blocks to effective practice.
This series is scheduled for the following dates. Sessions will take place in Wood W614, except where otherwise indicated:
Autumn 2008:
9 September
7 October
28 October in W500
18 November in W502
16 December
Winter-Spring 2008:
20 January
17 February
17 March
7 April
28 April
19 May
9 June
• Enrolment is set for a maximum of 12.
• Tentative Course fee: Until 15 August: £345; after 15 August: £395.
• The course could be taken for continuing professional education credit.
Professional Development Unit applications may be downloaded at http://www.strath.ac.uk/Departments/PDU/shortcourses/shortcourses.html (Note that that this course is not on the official list.)
Please direct enquiries to the PDU office (0141 950 3734) or Robert Elliott (Robert.Elliott@strath.ac.uk or fac0029@gmail.com ).
(version 15 July 2008)
Emotion-Focused Therapy: Level 2 Workshop Series
Facilitated by Robert Elliott
Professor of Counselling, University of Strathclyde
Wednesdays, 6-9pm, 10 September, 2008 – 27 May, 2009
Sir Henry Wood Building Room W312
Jordanhill Campus
University Of Strathclyde
(Sponsored by the Professional Development Unit, University of Strathclyde)
The Counselling Unit at the University of Strathclyde is offering further training in Emotion-Focused Therapy (EFT) for counsellors and psychotherapists (Diploma level or above) who have completed Level One training in EFT or the equivalent. This 14-session series will meet approximately every three weeks (see schedule for exceptions) throughout the 2007-08 academic year, beginning in September. The format will be a mixture of brief lectures, videos or demonstrations, experiential practice exercises in small groups, supervision of cases seen by course members, and discussion.
The specific topics to be covered are flexible based on participant interest, but will feature material not covered in the Level 1 course, such as
• Therapist experiential response modes
• Client modes of engagement
• Narrative Retelling of difficult/traumatic experiences
• Clearing a Space for overwhelming or chaotic experiences
• Relational Dialogue for Alliance difficulties
• Creation of Meaning for meaning protests
The Focusing and different forms of Chairwork will be particularly emphasized:
• Focusing with difficult or painful experiences
• Two chair enactment for Self-interruption splits
• Two chair conflict split work depression, anxiety and self-harm behavior
• Empty chair work for unfinished business
This series is scheduled for the following dates:
Autumn 2008:
10 September
1 October
22 October
19 November (note change in frequency)
10 December
Winter-Spring 2009:
14 January
4 February
25 February
18 March
1 April (note change in frequency)
22 April
6 May (note change in frequency)
27 May
10 June (note change in frequency)
• Enrolment is set for a maximum of 20.
• Course fee: Until 15 August: £395; after 15 August: £445
• The course could be taken for continuing professional education credit.
Professional Development Unit applications may be downloaded at http://www.strath.ac.uk/Departments/PDU/shortcourses/shortcourses.html (Note that that this course is not on the official list.)
Please direct enquiries to the PDU office (0141 950 3734) or Robert Elliott (Robert.Elliott@strath.ac.uk or fac0029@gmail.com ).
(version: 15/07/08)
Professor of Counselling, University of Strathclyde
Wednesdays, 6-9pm, 10 September, 2008 – 27 May, 2009
Sir Henry Wood Building Room W312
Jordanhill Campus
University Of Strathclyde
(Sponsored by the Professional Development Unit, University of Strathclyde)
The Counselling Unit at the University of Strathclyde is offering further training in Emotion-Focused Therapy (EFT) for counsellors and psychotherapists (Diploma level or above) who have completed Level One training in EFT or the equivalent. This 14-session series will meet approximately every three weeks (see schedule for exceptions) throughout the 2007-08 academic year, beginning in September. The format will be a mixture of brief lectures, videos or demonstrations, experiential practice exercises in small groups, supervision of cases seen by course members, and discussion.
The specific topics to be covered are flexible based on participant interest, but will feature material not covered in the Level 1 course, such as
• Therapist experiential response modes
• Client modes of engagement
• Narrative Retelling of difficult/traumatic experiences
• Clearing a Space for overwhelming or chaotic experiences
• Relational Dialogue for Alliance difficulties
• Creation of Meaning for meaning protests
The Focusing and different forms of Chairwork will be particularly emphasized:
• Focusing with difficult or painful experiences
• Two chair enactment for Self-interruption splits
• Two chair conflict split work depression, anxiety and self-harm behavior
• Empty chair work for unfinished business
This series is scheduled for the following dates:
Autumn 2008:
10 September
1 October
22 October
19 November (note change in frequency)
10 December
Winter-Spring 2009:
14 January
4 February
25 February
18 March
1 April (note change in frequency)
22 April
6 May (note change in frequency)
27 May
10 June (note change in frequency)
• Enrolment is set for a maximum of 20.
• Course fee: Until 15 August: £395; after 15 August: £445
• The course could be taken for continuing professional education credit.
Professional Development Unit applications may be downloaded at http://www.strath.ac.uk/Departments/PDU/shortcourses/shortcourses.html (Note that that this course is not on the official list.)
Please direct enquiries to the PDU office (0141 950 3734) or Robert Elliott (Robert.Elliott@strath.ac.uk or fac0029@gmail.com ).
(version: 15/07/08)
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