Entry for 21 October 2008:
This afternoon Brian proudly announced that research clinic had logged its 100th client: Since its first client contact last November, the Strathclyde Centre for Counselling & Psychotherapy has been contacted by 100 prospective clients.
Almost all of these clients have received telephone screenings; most have received intake screenings in one of our two research protocols; dozens have begun counselling; and a growing number have finished counselling. We now have a waiting list, which is a mixed blessing, but indicates the research clinic is clearly meeting a community need. We have logged several hundred sessions and sponsored three masters level dissertations by Counselling Psychology students (HSCED studies). As well as providing valuable training and practice opportunities for students and professional-level counsellors, as well as mental health services for folks from the Glasgow area, the research clinic is a research collective: That is, students and professionals contribute data as counsellors and researchers, and can then draw on the data set for their own research. As the the data archive builds, a wider variety of research projects becomes possible.
We are now interviewing the second cohort of students seeking placements in the research clinic. We are looking forward to seeing our 2nd hundred clients!
For more information, see the research clinic’s website: www.strath.ac.uk/Departments/counsunit/counselling/centre.html
Wednesday, October 22, 2008
Sunday, October 19, 2008
The Hermeneutic Circle
Entry for 19 Oct 2008:
Note. Some time ago I was asked to write a short piece on the Hermeneutic Circle for a research website at the University of Strathclyde. After putting it off for far too long, I decided I’d try it out as a blog entry. For the past 2 weeks, it has absorbed almost all my blogging energy, but I finally finished it this weekend.
Students in research methods courses often find the word “hermeneutic” and the associated concept of the Hermeneutic Circle to be intimidating pieces of technical philosophical/research jargon. For that reason, it is worth trying to unpack and demystify these concepts.
Hermeneutics
The word “hermeneutic” is really just a technical word for interpretation, but not necessarily interpretation in the psychoanalytic sense of interpreting unconscious phenomena. Instead, by focusing on how we make sense of complicated texts, hermeneutics brings our attention to one of the central issues in human existence: how it is possible for us to understand one another at all.
Although its etymology is obscure, it appears to be related to the Greek messenger god Hermes, who provides a handy metaphor for the act of interpretation, in that he was believed to deliver messages from the gods. In ancient times, important messages, as from one king to another, were delivered in the form of a scroll contained in a carrier tube, sealed with wax and stamped with the king’s signet ring. To receive the message, one would have to break the royal seal, remove the scroll from its concealing tube, and unroll it; all of these physical acts provide metaphors for the process of interpreting a difficult text or utterance.
Although typically traced to 18th century theologian/Bible scholars, the discipline of hermeneutics in fact goes back to the ancient Greek philosopher Aristotle (350 BCE/2007), who wrote a book on the grammatical/logical hermeneutics, commonly referred to by its Latin title, De Interpretatione (“On Interpretation”, in English). Aristotle was of course interested in the interpretation of linguistic statements in general; however, during the medieval and renaissance periods, its main focus was on the interpretation of the Bible (Biblical Hermeneutics), in terms of its multiple levels of meaning. Hermeneutics as systematic discipline became formalized by Friedrich Schleiermacher (1768-1834) and Wilhelm Dilthey (1833-1911) in the 18th and 19th centuries (Ramberg & Gjesdal, 2008).
For Bible scholars such as Friedrich Schleiermacher hermeneutics was the discipline of unpacking the meaning of ancient biblical sources, which are complicated, often damaged texts, dense with meaning of special significance to believers. Modern Bible scholars provide interesting examples of the hermeneutic method applied intensively to a single text over time: For example, Rudolf Bultmann (1884-1976) attempted to separate out the different layers of texts that had been written, revised and added to, over centuries.
Since Schleiermacher, modern hermeneutics has been developed successively by Dilthey, Heidegger, Gadamer, Habermas, and Ricoeur. Eventually, in the 1980’s, as part of the emergence of the qualitative research paradigm, this began to reach mainstream social sciences including psychology, sociology and education. Influential evaluation textbooks, such as early editions of Patton (2001) began to include sections on hermeneutic-interpretive research; Packer and Addison’s Entering the Circle (1989) marked the emergence of interest in hermeneutic methods in psychology. Today, the interpretive-hermeneutic approach is one of the main perspectives on qualitative research, alongside Grounded Theory (e.g., Strauss & Corbin, 1998) and empirical phenomenology (e.g., Wertz, 1983). In spite of superficial differences in intellectual tradition and terminology, the three overlap substantially with one another (McLeod, 2001). For example, Interpretative Phenomenological Analysis (IPA: Smith & Osborn, 2003), as its name suggests, combines elements of hermeneutics and empirical phenomenology.
The Hermeneutic Circle: How is Understanding Possible?
Formulation of the hermeneutic circle goes back to Spinoza and is the central organizing concept in hermeneutics (Ramberg & Gjesdal, 2008), serving as key metaphor, narrative, paradox or puzzle: In encountering a text, especially a dense, complex text, our understanding of each part is based on our understanding of the whole, including its personal and cultural context; and yet we can only build up our understanding of the whole (and its context) by understanding the different parts of which the text is constructed. Initially, our understanding of the whole is made up entirely of a “forestructure” of the expectations or pre-understandings that we have brought to our encounter with the text we are trying to understand. Paradoxically, it is these that make understanding possible in the first place; and yet, clearly, these expectations or even prejudices are at the same time the major impediment to truly understanding the text. Furthermore, this paradox is fundamental not only to our understanding of texts, but also our coming to know any novel situation or even other human beings. The hermeneutic circle thus raises the question of how it is possible for human beings to understand one another.
The answer to this puzzle turns out to be repeated careful readings, which means that the hermeneutic circle is really more of spiral, as we circle deeper and deeper into understanding a text, qualitative interview protocol, or another human being. This is because each encounter or reading brings us into contact with new aspects of the text or person, deepening our understanding. Our reading moves tentatively at first in a kind of dialog, back and forth, gradually both deepening and opening up the text or person to us. Although this process is never really complete, it eventually reaches far enough to satisfy our immediate purposes, whether as researchers, or counsellors, or fellow human beings. (refs)
What does this have to do with Research?
Rennie (2000) has proposed that this process applies to all forms of qualitative analysis, even those that claim to be descriptive, and that therefore hermeneutics is the core philosophy of science for qualitative research. It can even be argued that the hermeneutic circle applies as well to the process of developing and refining measures in quantitative research. Thinking hermeneutically encourages us to be aware of the pre-understandings we bring to our research, to read our data carefully and deeply and to circle through it repeatedly in stages of familiarization, unitizing, category construction, linking up aspects of the analysis, and review/self-audit, and writing up. It cautions us to avoid the easy philosophical solutions of either realism or relativism, but instead to step carefully along what Rennie refers to the rocky middle road between the two.
To learn more about hermeneutics and the hermeneutic circle, see the references below.
References
Aristotle. (350 BCE/2007). On interpretation (Trans. E.A Edgehill). Accessed on 16 October 2008, at http://etext.library.adelaide.edu.au/a/aristotle/interpretation/.
Elliott, R. (1989). Comprehensive Process Analysis: Understanding the change process in significant therapy events. In M. Packer & R.B. Addison (Eds.), Entering the circle: Hermeneutic investigation in psychology (pp. 165-184). Albany, NY: SUNY Press.
Elliott, R. (1993). Carrying out a Comprehensive Process Analysis. Unpublished paper. University of Toledo, Toledo, Ohio USA. [available by request]
McLeod, J. (2001). Qualitative research in counselling and psychotherapy. London, UK: Sage.
Packer, M.J., & Addison, R.B. (Eds.). (1989). Entering the circle: Hermeneutic investigation in psychology. Albany, NY: SUNY Press.
Patton, M.Q. (2001). Qualitative evaluation and research methods (3nd ed.). London, UK: Sage.
Ramberg, B., & Gjesdal, K. (2008). Hermeneutics, in E. N. Zalta (ed.), The Stanford Encyclopedia of Philosophy (Fall 2008 Edition). Accessed on 5 October 2008, at http://plato.stanford.edu/archives/fall2008/entries/hermeneutics/ .
Rennie, D.L. (2000). Grounded theory methodology as methodical hermeneutics: Reconciling realism and relativism. Theory & Psychology, 10, 481-502.
Smith, J.A. and Osborn, M. (2003) Interpretative phenomenological analysis. In J.A. Smith (Ed.), Qualitative Psychology: A Practical Guide to Methods. London: Sage.
Wertz, F.J. (1983). From everyday to psychological description: Analyzing the moments of a qualitative data analysis. Journal of Phenomenological Psychology, 14, 197-241.
Note. Some time ago I was asked to write a short piece on the Hermeneutic Circle for a research website at the University of Strathclyde. After putting it off for far too long, I decided I’d try it out as a blog entry. For the past 2 weeks, it has absorbed almost all my blogging energy, but I finally finished it this weekend.
Students in research methods courses often find the word “hermeneutic” and the associated concept of the Hermeneutic Circle to be intimidating pieces of technical philosophical/research jargon. For that reason, it is worth trying to unpack and demystify these concepts.
Hermeneutics
The word “hermeneutic” is really just a technical word for interpretation, but not necessarily interpretation in the psychoanalytic sense of interpreting unconscious phenomena. Instead, by focusing on how we make sense of complicated texts, hermeneutics brings our attention to one of the central issues in human existence: how it is possible for us to understand one another at all.
Although its etymology is obscure, it appears to be related to the Greek messenger god Hermes, who provides a handy metaphor for the act of interpretation, in that he was believed to deliver messages from the gods. In ancient times, important messages, as from one king to another, were delivered in the form of a scroll contained in a carrier tube, sealed with wax and stamped with the king’s signet ring. To receive the message, one would have to break the royal seal, remove the scroll from its concealing tube, and unroll it; all of these physical acts provide metaphors for the process of interpreting a difficult text or utterance.
Although typically traced to 18th century theologian/Bible scholars, the discipline of hermeneutics in fact goes back to the ancient Greek philosopher Aristotle (350 BCE/2007), who wrote a book on the grammatical/logical hermeneutics, commonly referred to by its Latin title, De Interpretatione (“On Interpretation”, in English). Aristotle was of course interested in the interpretation of linguistic statements in general; however, during the medieval and renaissance periods, its main focus was on the interpretation of the Bible (Biblical Hermeneutics), in terms of its multiple levels of meaning. Hermeneutics as systematic discipline became formalized by Friedrich Schleiermacher (1768-1834) and Wilhelm Dilthey (1833-1911) in the 18th and 19th centuries (Ramberg & Gjesdal, 2008).
For Bible scholars such as Friedrich Schleiermacher hermeneutics was the discipline of unpacking the meaning of ancient biblical sources, which are complicated, often damaged texts, dense with meaning of special significance to believers. Modern Bible scholars provide interesting examples of the hermeneutic method applied intensively to a single text over time: For example, Rudolf Bultmann (1884-1976) attempted to separate out the different layers of texts that had been written, revised and added to, over centuries.
Since Schleiermacher, modern hermeneutics has been developed successively by Dilthey, Heidegger, Gadamer, Habermas, and Ricoeur. Eventually, in the 1980’s, as part of the emergence of the qualitative research paradigm, this began to reach mainstream social sciences including psychology, sociology and education. Influential evaluation textbooks, such as early editions of Patton (2001) began to include sections on hermeneutic-interpretive research; Packer and Addison’s Entering the Circle (1989) marked the emergence of interest in hermeneutic methods in psychology. Today, the interpretive-hermeneutic approach is one of the main perspectives on qualitative research, alongside Grounded Theory (e.g., Strauss & Corbin, 1998) and empirical phenomenology (e.g., Wertz, 1983). In spite of superficial differences in intellectual tradition and terminology, the three overlap substantially with one another (McLeod, 2001). For example, Interpretative Phenomenological Analysis (IPA: Smith & Osborn, 2003), as its name suggests, combines elements of hermeneutics and empirical phenomenology.
The Hermeneutic Circle: How is Understanding Possible?
Formulation of the hermeneutic circle goes back to Spinoza and is the central organizing concept in hermeneutics (Ramberg & Gjesdal, 2008), serving as key metaphor, narrative, paradox or puzzle: In encountering a text, especially a dense, complex text, our understanding of each part is based on our understanding of the whole, including its personal and cultural context; and yet we can only build up our understanding of the whole (and its context) by understanding the different parts of which the text is constructed. Initially, our understanding of the whole is made up entirely of a “forestructure” of the expectations or pre-understandings that we have brought to our encounter with the text we are trying to understand. Paradoxically, it is these that make understanding possible in the first place; and yet, clearly, these expectations or even prejudices are at the same time the major impediment to truly understanding the text. Furthermore, this paradox is fundamental not only to our understanding of texts, but also our coming to know any novel situation or even other human beings. The hermeneutic circle thus raises the question of how it is possible for human beings to understand one another.
The answer to this puzzle turns out to be repeated careful readings, which means that the hermeneutic circle is really more of spiral, as we circle deeper and deeper into understanding a text, qualitative interview protocol, or another human being. This is because each encounter or reading brings us into contact with new aspects of the text or person, deepening our understanding. Our reading moves tentatively at first in a kind of dialog, back and forth, gradually both deepening and opening up the text or person to us. Although this process is never really complete, it eventually reaches far enough to satisfy our immediate purposes, whether as researchers, or counsellors, or fellow human beings. (refs)
What does this have to do with Research?
Rennie (2000) has proposed that this process applies to all forms of qualitative analysis, even those that claim to be descriptive, and that therefore hermeneutics is the core philosophy of science for qualitative research. It can even be argued that the hermeneutic circle applies as well to the process of developing and refining measures in quantitative research. Thinking hermeneutically encourages us to be aware of the pre-understandings we bring to our research, to read our data carefully and deeply and to circle through it repeatedly in stages of familiarization, unitizing, category construction, linking up aspects of the analysis, and review/self-audit, and writing up. It cautions us to avoid the easy philosophical solutions of either realism or relativism, but instead to step carefully along what Rennie refers to the rocky middle road between the two.
To learn more about hermeneutics and the hermeneutic circle, see the references below.
References
Aristotle. (350 BCE/2007). On interpretation (Trans. E.A Edgehill). Accessed on 16 October 2008, at http://etext.library.adelaide.edu.au/a/aristotle/interpretation/.
Elliott, R. (1989). Comprehensive Process Analysis: Understanding the change process in significant therapy events. In M. Packer & R.B. Addison (Eds.), Entering the circle: Hermeneutic investigation in psychology (pp. 165-184). Albany, NY: SUNY Press.
Elliott, R. (1993). Carrying out a Comprehensive Process Analysis. Unpublished paper. University of Toledo, Toledo, Ohio USA. [available by request]
McLeod, J. (2001). Qualitative research in counselling and psychotherapy. London, UK: Sage.
Packer, M.J., & Addison, R.B. (Eds.). (1989). Entering the circle: Hermeneutic investigation in psychology. Albany, NY: SUNY Press.
Patton, M.Q. (2001). Qualitative evaluation and research methods (3nd ed.). London, UK: Sage.
Ramberg, B., & Gjesdal, K. (2008). Hermeneutics, in E. N. Zalta (ed.), The Stanford Encyclopedia of Philosophy (Fall 2008 Edition). Accessed on 5 October 2008, at http://plato.stanford.edu/archives/fall2008/entries/hermeneutics/ .
Rennie, D.L. (2000). Grounded theory methodology as methodical hermeneutics: Reconciling realism and relativism. Theory & Psychology, 10, 481-502.
Smith, J.A. and Osborn, M. (2003) Interpretative phenomenological analysis. In J.A. Smith (Ed.), Qualitative Psychology: A Practical Guide to Methods. London: Sage.
Wertz, F.J. (1983). From everyday to psychological description: Analyzing the moments of a qualitative data analysis. Journal of Phenomenological Psychology, 14, 197-241.
Saturday, October 18, 2008
Emotion Focused Therapy (EFT) training with Les Greenberg, PhD
Les Greenberg has asked me to let people know about his upcoming EFT training workshops. He certainly keeps himself busy! -Robert
EFT Institutes provide participants with a solid grounding in the skills required to work more directly with emotion in psychotherapy. Participants receive in-depth skills training through a combination of brief lectures, video demonstrations, live modeling, case discussions, and extensive supervised role-playing practice.
Les Greenberg, Ph.D. is a Professor of Psychology at York University. He is the Founder of Emotion Focused Therapy and the Director of the York University Psychotherapy Research Center.
The Applied Psychology Institute is approved by the Canadian Psychological Association to offer continuing education for psychologists. API maintains responsibility for all programs.
Couples EFT Institute, Level I
November 9-12, 2008 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario
Individual EFT Institute, Level I
August 10-13, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, ON
Individual EFT Institute, Level II (option #1)
October 21-24, 2008 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario
Individual EFT Institute, Level II (option #2)
February 23-26, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Palm Desert, California
Individual EFT Institute, Level II (option #3)
August 17-20, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, ON
Individual EFT Institute, Level III
October 2-4, 2009 (18 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario
See www.emotionfocusedtherapy.org <http://www.emotionfocusedtherapy.org/ > for registration details.
--
Leslie S. Greenberg
Professor, Dept. of Psychology
York University
4700 Keele St. Toronto, ON, Canada M3J 1P3
Phone (416) 736-5115 x66111
Fax (416) 736-5814
http://www.EmotionFocusedTherapy.org
http://www.psych.yorku.ca/greenberg
EFT Institutes provide participants with a solid grounding in the skills required to work more directly with emotion in psychotherapy. Participants receive in-depth skills training through a combination of brief lectures, video demonstrations, live modeling, case discussions, and extensive supervised role-playing practice.
Les Greenberg, Ph.D. is a Professor of Psychology at York University. He is the Founder of Emotion Focused Therapy and the Director of the York University Psychotherapy Research Center.
The Applied Psychology Institute is approved by the Canadian Psychological Association to offer continuing education for psychologists. API maintains responsibility for all programs.
Couples EFT Institute, Level I
November 9-12, 2008 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario
Individual EFT Institute, Level I
August 10-13, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, ON
Individual EFT Institute, Level II (option #1)
October 21-24, 2008 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario
Individual EFT Institute, Level II (option #2)
February 23-26, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Palm Desert, California
Individual EFT Institute, Level II (option #3)
August 17-20, 2009 (24 CEUs)
Presented by Les Greenberg, PhD
Toronto, ON
Individual EFT Institute, Level III
October 2-4, 2009 (18 CEUs)
Presented by Les Greenberg, PhD
Toronto, Ontario
See www.emotionfocusedtherapy.org <http://www.
--
Leslie S. Greenberg
Professor, Dept. of Psychology
York University
4700 Keele St. Toronto, ON, Canada M3J 1P3
Phone (416) 736-5115 x66111
Fax (416) 736-5814
http://www.
http://www.psych.yorku.ca/
Saturday, October 11, 2008
Mitchell Library
Entry for 11 October 2008:
Today was a lovely, though cool, day in Glasgow. After a heavy week of teaching and rain, it was a relief to be able to get up this morning and do a 10-mile run along the canals in the morning sunshine. For this week's Saturday Adventure, Diane and I visited the Mitchell Library, an imposing structure on edge of the city Centre, which we’d walked past many times without going in. We spent most of our time in then Glasgow Collection, a room full of a really nice collection of books, graphics, maps etc on Glasgow, among their other collections. In an obscure corner of the Library we stumbled upon a room full of the most marvellous puppets from all over the world, piled cheek by jowl next to each other. Magical! A return visit will make a lovely outing for some future rainy Saturday.
Today was a lovely, though cool, day in Glasgow. After a heavy week of teaching and rain, it was a relief to be able to get up this morning and do a 10-mile run along the canals in the morning sunshine. For this week's Saturday Adventure, Diane and I visited the Mitchell Library, an imposing structure on edge of the city Centre, which we’d walked past many times without going in. We spent most of our time in then Glasgow Collection, a room full of a really nice collection of books, graphics, maps etc on Glasgow, among their other collections. In an obscure corner of the Library we stumbled upon a room full of the most marvellous puppets from all over the world, piled cheek by jowl next to each other. Magical! A return visit will make a lovely outing for some future rainy Saturday.
Tuesday, September 30, 2008
New Litany for Running
Entry for 27 September 2008:
While I‘m out running, I have a little litany or prayer that I have been doing for many years (since about the time I turned 50, actually). The basic form starts like this:
Then I continue with the second part, which I usually reach in the last few minutes of my run:
However, in past few years, the meaning of the “I” in “I don’t know where I came from, etc” has shifted to something closer to: “the small, limited part of me that calls itself ‘I’ die”. And usually when I get to this part of the litany, something in me answers back that it doesn’t really buy this anymore.
This is because this something in me has really come to believe something closer to:
While I‘m out running, I have a little litany or prayer that I have been doing for many years (since about the time I turned 50, actually). The basic form starts like this:
Lady of the Universe,In the blank, I insert the name of various people for whom I have some concern: a family member, a client, a colleague, one of my children, and usually myself. I then imagine this person surrounded by light.
You hold all things in your hands,
You hold each of us in your hands;
I ask you to hold ____ in your hands.
Then I continue with the second part, which I usually reach in the last few minutes of my run:
Lady of the Universe,Over the years, this little litany has helped me face and acknowledge my fear of death, which has largely dissolved in the face of this “radical acceptance” (to use Ann Weiser Cornell’s memorable phrase).
I don’t know where I came from before I was born,
And I don’t know what will happen to me when I die.
As far as I know, I come from nothing,
And when I die, I go to nothing.
Therefore, every moment is a gift,
every day is a gift,
every month is a gift,
every year is a gift,
and my life, my ___ years are gift.
However, in past few years, the meaning of the “I” in “I don’t know where I came from, etc” has shifted to something closer to: “the small, limited part of me that calls itself ‘I’ die”. And usually when I get to this part of the litany, something in me answers back that it doesn’t really buy this anymore.
This is because this something in me has really come to believe something closer to:
Lady of the Universe,This is what feels true to me know, and what gives me a sense of peace and acceptance. So last Saturday, coming back from a long, nearly 8-mile run, on a lovely late September Glasgow morning, I decided that it is time for a new version of my Running Litany, along the lines suggested. I’m not sure I’ve got the words exactly right, but it’s a start, which I plan to try out over the next couple of weeks.
I know that I come out of all that has gone before me,
And that all this continues to live in me,
In the same way that I will still continue to live,
as part of the pattern everything around me,
Living in all those I’ve known
and touched in some way.
This is the gift of this day, this moment,
this year and this life,
and is to be treasured and rejoiced in … forever.
Saturday, September 20, 2008
HPCE Expert Reference Group, Part 5
Entry for 19 September
1. Heisenberg’s Uncertainty Principle Applied to Blogged ERG Proceedings. Possibly the most closely followed of my blog entries has been the series of pieces I’ve written on the Skills for Health project Mick and I have been involved in since last January. The Humanistic-Person-Centred-Experiential Expert Reference Group (HPCE-ERG), as it has come to be called, has been controversial from the beginning. I have documented some of this, and of course in my early entries I have been fairly critical of the methods being used, and in particular the excessive reliance on RCTs as the ultimate arbiter of what would be included or not. Although I still have some misgivings, I’ve been impressed over time by the quality of the discussions and the opportunity for dialog, as well as what is beginning to emerge from the process.
The amusing thing is that it turns out that Tony Roth and Steve Pilling have been following these blog entries, so that the process of blog-observing the HPCE ERG meetings has altered them. At one point at the meeting this past Monday, Tony turned to Steve and told him to put down his chainsaw, a reference to a metaphor I used in my pieces on the March and June meetings. And at the end of the meeting, Tony said he was looking forward to hearing about the meeting in the blogosphere. So here I am, called back from my Blog Block by colleagues whom I’d criticized earlier, and I am left not wanting to disappoint them.
2. Steady progress on the competency framework. Thanks to Alison and Andy’s efforts, the HPCE competence framework is continuing to shape up. The overall, top-level framework, a one-page summary overview chart, looks to me to be in good shape, and the detailed list underneath it is progressing. We spent most of our time going over sections of the latter, trying to flesh it out more concretely, paying particular attention to theory-knowledge competence, which required spelling out what the essential elements of the theory are, and elements of the relational competence. For example, how do you describe what the therapist does to foster “collaborative contact”? Should “presence” be developed as a competence beyond or in addition to the three facilitative conditions? These discussions have been stimulating, fun, collaborative and illuminating.
3. Continued Scoping: Steve and I reported back to the group the results of our continued attempts to scope out data that might warrant including Gestalt and Psychodrama. Back in July, I made another attempt to pull something out of the Gestalt and Psychodrama literatures, which was the basis for a teleconference among Tony, Steve and I. Alas, our efforts were in vain; we are unable to find more than a single decent RCT for one client group for either of these approaches, and for now Gestalt and Psychodrama will continue to languish in the margins of the competence process, as what I am going to refer to below as Ghost Entries.
4. UKCP’s Dilemma: A Modest Proposal. Because of my aversion to flying within the UK, I again arrived 90 minutes into our latest meeting. I had missed a difficult discussion between Vanja Orlans, who again had been saddled with the thankless task of conveying to the group a Bill of Complaint from UKCP. Representatives of the latter had had another meeting with Lord Alderdice and Peter Fonagy, from my point of view trying to accomplish with lobbying what they didn’t have the data to support. By the time I got there, the difficult discussion was done and it was almost time for lunch. I felt somewhat guilty for having missed the experience, but also relieved. However, I did not entirely escape the controversy: Tony gave me a summary, and at the end of the day Vanja stayed on for a bit after, and she, Tony and I went over some of the arguments again. Vanja was frustrated with me for not having been there in the morning to support her position, but the problem was that I had by now gone over to the Dark Side and was prepared offer qualified support for the HPCE ERG project, warts and all.
I have very mixed feelings about the series of complaints that UKCP has lodged against the HPCE ERG process since it began. My very first impression was that they had been caught trying to pull a fast one at the very beginning, having persuaded the Skills for Health folks that Humanistic and Integrative Psychotherapy was a meaningful, conceptually coherent theoretical orientation on the same order as CBT or Psychodynamic psychotherapy. This struck me then and continues to strike me today as an attempt to dress up, in nice scientific and professional clothing, a political compromise by which a collection of humanistic and various other therapists banded together to increase their clout.
Historically, as I now understand it, a body of training, practice and philosophy has by now grown up around this compromise, and I have been impressed by the position that Vanja has put forward. Nevertheless, there are several problems with integrative psychotherapy as a basis for a competency framework: (1) The list of therapies involved is a long and variegated one (which includes Process-Experiential/Emotion-Focused Therapy as well as Cognitive Analytic Therapy), with little in common except that they don’t fit anywhere else. (2) The research basis for this group of therapies is fairly poor, so that it provides little grist for the ERG process Steve and Tony have set up. Even if Steve and Tony’s inclusion rules were relaxed somewhat, there still wouldn’t be much. (3) Unlike PE-EFT, this approach to integrative therapy runs beyond the confines of humanistic therapy, to psychodynamic approaches in particular; so it really cuts across theoretical modalities, creating an inherent difficulty for a modality-based competency approach, and threatening to break the process even if it were to be tried.
But where does this leave us? As I have come to understand it, what Vanja and her colleagues at Metanoia are trying to do with their formulation of a personalized integration approach is admirable, makes sense, and is a Good Thing. I did the same thing at the University of Toledo, but certainly without as much intellectual rigor: The idea is that each student should, through a careful, self-reflective process, develop their own personal integration, building on systematic exposure to multiple theoretical modalities. However, this doesn’t make sense to me as a basis for a competency framework; in fact, given the assumptions of the approach, it should be impossible, or at least seriously unwise, to do so.
Instead, if you are going to integrate humanistic with other therapies, the thing to do is to use multiple competence frameworks from which to draw one’s personal integration. When they are completed, the various competence frameworks now being developed will provide a valuable tool for this process. The ERG competence process is the not the enemy of Humanistic and Integrative Psychotherapy (HIPS), but its helpmate. In fact, this appears to be exactly what Lord Alderdice and Peter Fonagy have recommended to them. Let UKCP’s HIPS section proclaim superiority by owning all the frameworks!
5. Ghost Entries: More Modest Proposals. As noted, Focusing, Pre-therapy, Gestalt and Psychodrama all fall within the HPCE camp, but because of their lack of RCTs (or even, I would say, RCT-equivalents) and therapy manuals, they remain the equivalent of Brown Dwarfs in the evidence-based therapy firmament, their Dark Matter exerting a strong gravitational force, without the visibility they desire. In the emerging HPCE competence framework, they are the Ghost Entries in the Specific HPCE Adaptations column: their proper place is alongside PE-EFT, currently the sole visible inhabitant of that region of the framework.
Given that the Ghost Entries belong in the framework but currently lack the evidence base to qualify formally, what should they do? I have two suggestions:
The HPCE Expert Reference Group will continue to meet, for at least more meeting in November, and I'm looking forward to it already!
1. Heisenberg’s Uncertainty Principle Applied to Blogged ERG Proceedings. Possibly the most closely followed of my blog entries has been the series of pieces I’ve written on the Skills for Health project Mick and I have been involved in since last January. The Humanistic-Person-Centred-Experiential Expert Reference Group (HPCE-ERG), as it has come to be called, has been controversial from the beginning. I have documented some of this, and of course in my early entries I have been fairly critical of the methods being used, and in particular the excessive reliance on RCTs as the ultimate arbiter of what would be included or not. Although I still have some misgivings, I’ve been impressed over time by the quality of the discussions and the opportunity for dialog, as well as what is beginning to emerge from the process.
The amusing thing is that it turns out that Tony Roth and Steve Pilling have been following these blog entries, so that the process of blog-observing the HPCE ERG meetings has altered them. At one point at the meeting this past Monday, Tony turned to Steve and told him to put down his chainsaw, a reference to a metaphor I used in my pieces on the March and June meetings. And at the end of the meeting, Tony said he was looking forward to hearing about the meeting in the blogosphere. So here I am, called back from my Blog Block by colleagues whom I’d criticized earlier, and I am left not wanting to disappoint them.
2. Steady progress on the competency framework. Thanks to Alison and Andy’s efforts, the HPCE competence framework is continuing to shape up. The overall, top-level framework, a one-page summary overview chart, looks to me to be in good shape, and the detailed list underneath it is progressing. We spent most of our time going over sections of the latter, trying to flesh it out more concretely, paying particular attention to theory-knowledge competence, which required spelling out what the essential elements of the theory are, and elements of the relational competence. For example, how do you describe what the therapist does to foster “collaborative contact”? Should “presence” be developed as a competence beyond or in addition to the three facilitative conditions? These discussions have been stimulating, fun, collaborative and illuminating.
3. Continued Scoping: Steve and I reported back to the group the results of our continued attempts to scope out data that might warrant including Gestalt and Psychodrama. Back in July, I made another attempt to pull something out of the Gestalt and Psychodrama literatures, which was the basis for a teleconference among Tony, Steve and I. Alas, our efforts were in vain; we are unable to find more than a single decent RCT for one client group for either of these approaches, and for now Gestalt and Psychodrama will continue to languish in the margins of the competence process, as what I am going to refer to below as Ghost Entries.
4. UKCP’s Dilemma: A Modest Proposal. Because of my aversion to flying within the UK, I again arrived 90 minutes into our latest meeting. I had missed a difficult discussion between Vanja Orlans, who again had been saddled with the thankless task of conveying to the group a Bill of Complaint from UKCP. Representatives of the latter had had another meeting with Lord Alderdice and Peter Fonagy, from my point of view trying to accomplish with lobbying what they didn’t have the data to support. By the time I got there, the difficult discussion was done and it was almost time for lunch. I felt somewhat guilty for having missed the experience, but also relieved. However, I did not entirely escape the controversy: Tony gave me a summary, and at the end of the day Vanja stayed on for a bit after, and she, Tony and I went over some of the arguments again. Vanja was frustrated with me for not having been there in the morning to support her position, but the problem was that I had by now gone over to the Dark Side and was prepared offer qualified support for the HPCE ERG project, warts and all.
I have very mixed feelings about the series of complaints that UKCP has lodged against the HPCE ERG process since it began. My very first impression was that they had been caught trying to pull a fast one at the very beginning, having persuaded the Skills for Health folks that Humanistic and Integrative Psychotherapy was a meaningful, conceptually coherent theoretical orientation on the same order as CBT or Psychodynamic psychotherapy. This struck me then and continues to strike me today as an attempt to dress up, in nice scientific and professional clothing, a political compromise by which a collection of humanistic and various other therapists banded together to increase their clout.
Historically, as I now understand it, a body of training, practice and philosophy has by now grown up around this compromise, and I have been impressed by the position that Vanja has put forward. Nevertheless, there are several problems with integrative psychotherapy as a basis for a competency framework: (1) The list of therapies involved is a long and variegated one (which includes Process-Experiential/Emotion-Focused Therapy as well as Cognitive Analytic Therapy), with little in common except that they don’t fit anywhere else. (2) The research basis for this group of therapies is fairly poor, so that it provides little grist for the ERG process Steve and Tony have set up. Even if Steve and Tony’s inclusion rules were relaxed somewhat, there still wouldn’t be much. (3) Unlike PE-EFT, this approach to integrative therapy runs beyond the confines of humanistic therapy, to psychodynamic approaches in particular; so it really cuts across theoretical modalities, creating an inherent difficulty for a modality-based competency approach, and threatening to break the process even if it were to be tried.
But where does this leave us? As I have come to understand it, what Vanja and her colleagues at Metanoia are trying to do with their formulation of a personalized integration approach is admirable, makes sense, and is a Good Thing. I did the same thing at the University of Toledo, but certainly without as much intellectual rigor: The idea is that each student should, through a careful, self-reflective process, develop their own personal integration, building on systematic exposure to multiple theoretical modalities. However, this doesn’t make sense to me as a basis for a competency framework; in fact, given the assumptions of the approach, it should be impossible, or at least seriously unwise, to do so.
Instead, if you are going to integrate humanistic with other therapies, the thing to do is to use multiple competence frameworks from which to draw one’s personal integration. When they are completed, the various competence frameworks now being developed will provide a valuable tool for this process. The ERG competence process is the not the enemy of Humanistic and Integrative Psychotherapy (HIPS), but its helpmate. In fact, this appears to be exactly what Lord Alderdice and Peter Fonagy have recommended to them. Let UKCP’s HIPS section proclaim superiority by owning all the frameworks!
5. Ghost Entries: More Modest Proposals. As noted, Focusing, Pre-therapy, Gestalt and Psychodrama all fall within the HPCE camp, but because of their lack of RCTs (or even, I would say, RCT-equivalents) and therapy manuals, they remain the equivalent of Brown Dwarfs in the evidence-based therapy firmament, their Dark Matter exerting a strong gravitational force, without the visibility they desire. In the emerging HPCE competence framework, they are the Ghost Entries in the Specific HPCE Adaptations column: their proper place is alongside PE-EFT, currently the sole visible inhabitant of that region of the framework.
Given that the Ghost Entries belong in the framework but currently lack the evidence base to qualify formally, what should they do? I have two suggestions:
(1) Jump-starting research. First, they need to start doing systematic, well-designed, focused research on key client populations. Below, I use Pre-therapy as an example of what I’m talking about. It is important to recognize the possibility that some of the ghost therapies are not going to turn out to be as effective for particular client groups as they might have hoped. The psychotherapy field of full of treatments that people swore worked but turned out not to really be effective, at least not without significant further adaptation.6. How to get Pre-Therapy on the Map. Every meeting, Catherine Clarke, our caregiver member, makes an impassioned plea for the inclusion of Pre-therapy. Pre-therapy, developed by Gary Prouty for work with clients who are out of contact because of a psychotic process, is another of our highly-promising Ghost Entries and one whose practice is spreading rapidly in the UK, but is presently excluded because it lacks a strong research base. Catherine has seen how effective Pre-therapy was for her son, and also how ineffective other approaches have been; she is also aware of the harm being done by over-medicating people living with psychotic processes, so she takes the omission of Pre-therapy personally. Every meeting we listen to her, and I say that the Pre-therapy folks need to start doing more research, but somehow this isn’t enough. At this week’s meeting, it was clear that she was feeling fairly discouraged, and so I said that I would offer some suggestions for a strategy forward. So here is what I am proposing to the Pre-therapy Network:
(2) Open-Sourcing the ERG Process. Second, rather than bemoaning their exclusion from the competence framework, they should go ahead and actually create their own Ghost Entries for the framework (or if you prefer a more political metaphor, they should create shadow cabinets). That is, they should use the methods that Alison and Andy are using to generate the Specific HPCE Adaptation competences for Process-Experiential Therapy. Actually, these haven’t been done yet, but they will be in the next couple of months, but once they are drafted, they will provide a template for other specific adaptations, like Psychodrama, Gestalt, etc, to use. These Ghost or Shadow Competence HPCE Adaptation modules can be offered as a supplement to the official HPCE framework, and can also be used to support research, as in my first suggestion.
(1) Pretherapy practitioners need to form a Practitioner Research Network (PRN) to develop controlled collaborative research using a shared research protocol. No one is going to do this research for you; you will have to do it yourselves! Wendy Traynor has just spent the past year developing such a research protocol, and is willing to act as a consultant for the project. The Pre-therapy Network already exists and provides an existing basis for this kind of collaboration; it is exactly the kind of organizational structure that is needed to support a PRN.A similar stagewise process can be used for other therapies not currently included, but its important for them to focus on a key client group, such as depression or generalized anxiety, rather than doing scattershot studies that don’t cumulate.
(2) Study 1: After getting ethics approval (Wendy is about to submit her protocol to NHS Ethics) involves as many members of the network as possible to track one new client through a psychotic process using Pre-therapy, measuring process and outcome following Wendy’s protocol, using the HSCED method to analyze whether the client changed and whether therapy was responsible for the changes. Keep track of client outcome over the course of therapy, but evaluate intensively during episodes of psychotic process, so that Pre-therapy phases of therapy can be evaluated inside the longer course of therapy.
(3) This needs to be done from at least 5 – 10 clients, making a clinical case series of systematic case studies. Until you do this, you don’t have a clear sense of the generalizability of the results of the case study in Step 2 or of the older studies reviewed by Dekeyser et al. (2008)
(4) Study 2 is a controlled outcome study against Treatment as Usual, with randomization. This is can done using a cluster design: randomize pairs of clients in relevant agencies, one to receive treatment as usual, the other Pre-therapy.
(5) Study 3: A different group of pre-therapy researchers then replicates this study. Alternatively, you can use the infrastructure from the first set of studies to compare Pre-therapy to a different therapy, like CBT.
The HPCE Expert Reference Group will continue to meet, for at least more meeting in November, and I'm looking forward to it already!
Thursday, September 18, 2008
Blog Block
Entry for 16 September 2008:
I’ve found writing my blog increasingly difficult over the past few months. This blog started small, really at the request of my kids, who said to me two years ago, as we were leaving Toledo to move to Scotland, “Dad, you’ve got to start a blog, so we can keep up with what you and mom and doing!” So I started writing, for them, about our daily adventures fitting into our new life in Scotland, including our practice of Saturday Adventures. (To this day, my mom is my most faithful reader. Hi, Mom!)
Then, because a large part of the adventure and the strangeness was my work, I began to write out that as well. Somehow, word got out to my colleagues that I was keeping a blog (probably I told them), so some of them started reading the blog also. At some point, I told my students about the blog, so some of them started following it also, especially the entries about my adventures teaching, which were many and various. From time to time, a stranger, or an anonymous acquaintance posts a comment, when a search leads them to some relevant entry of mine. (Early on, I had to start moderating comments to prevent spammers form posting ads or garbage.) Finally, I began writing about the politics of Person-Centred/Experiential therapy in Scotland and the UK, and an even larger readership emerged.
Over time, however, with the accumulating, diverse audience and various things that came up, it has become increasingly complicated to write the blog. When I started to see clients, a year ago, a big portion of my creative energy got steered back to my client work, where I have, among other things, been developing ideas about working with social anxiety and couples work. Of course, it’s really difficult to write safe blogs about clinical work while protecting clients’ confidentiality, and it’s also possible one of my clients will read an entry about themselves or another client. So that had to go underground. Furthermore, not everyone has been happy about what I have written in the blog, and a couple of people have complained about what they read there. Blogs are supposed to be an informal, personal and spontaneous communication medium, but it’s so new that the social norms and etiquette are still emerging. The result was that some toes got stepped on, and more and more things haven’t felt safe to write about. With this, the blog has become less and less fun to do, because I have had to be more and more careful what I say. Instead of a creative outlet, I’ve felt squelched and have found it more and more difficult to write. One result is the safe little pieces about my publications, for example.
Hence, my relative silence over the past month, while various significant things have gone unmentioned: During our 4-week visit to the US, my mom fell and broke her foot while we were visiting her in Murray Creek. I flew to Boston for the Humanistic Psychology conference and American Psychological Association conference, where I received the Carl Rogers Award for Contributions to Humanistic Psychology and had a lovely, memorable visit with my famous, fun cousin Courtenay Harding. We moved Kenneth back to his dorm and said goodbye to Brendan and Mayumi as they prepared to leave Cleveland and move to Seattle, Washington. And we brought Diane’s mom, Gladys back to Glasgow with us for a two-week visit. Things started off intensely at work, which huge piles of work waiting for me, papers to grade, exam board, clients, students, ever-mounting pile of email, job interviews, courses starting in new configurations, various crises etc etc.
Part of the issue is that I’ve been run too ragged to write about it, but it is more than that: it wasn’t fun, and I didn’t have any long, unstructured trips during which to just sit and see what comes. I miss that. It's probably inevitable, but it does feel a bit like my running: If I'm too busy to carry on with it, then it means that my life is too busy and something needs to give, period!
I’ve found writing my blog increasingly difficult over the past few months. This blog started small, really at the request of my kids, who said to me two years ago, as we were leaving Toledo to move to Scotland, “Dad, you’ve got to start a blog, so we can keep up with what you and mom and doing!” So I started writing, for them, about our daily adventures fitting into our new life in Scotland, including our practice of Saturday Adventures. (To this day, my mom is my most faithful reader. Hi, Mom!)
Then, because a large part of the adventure and the strangeness was my work, I began to write out that as well. Somehow, word got out to my colleagues that I was keeping a blog (probably I told them), so some of them started reading the blog also. At some point, I told my students about the blog, so some of them started following it also, especially the entries about my adventures teaching, which were many and various. From time to time, a stranger, or an anonymous acquaintance posts a comment, when a search leads them to some relevant entry of mine. (Early on, I had to start moderating comments to prevent spammers form posting ads or garbage.) Finally, I began writing about the politics of Person-Centred/Experiential therapy in Scotland and the UK, and an even larger readership emerged.
Over time, however, with the accumulating, diverse audience and various things that came up, it has become increasingly complicated to write the blog. When I started to see clients, a year ago, a big portion of my creative energy got steered back to my client work, where I have, among other things, been developing ideas about working with social anxiety and couples work. Of course, it’s really difficult to write safe blogs about clinical work while protecting clients’ confidentiality, and it’s also possible one of my clients will read an entry about themselves or another client. So that had to go underground. Furthermore, not everyone has been happy about what I have written in the blog, and a couple of people have complained about what they read there. Blogs are supposed to be an informal, personal and spontaneous communication medium, but it’s so new that the social norms and etiquette are still emerging. The result was that some toes got stepped on, and more and more things haven’t felt safe to write about. With this, the blog has become less and less fun to do, because I have had to be more and more careful what I say. Instead of a creative outlet, I’ve felt squelched and have found it more and more difficult to write. One result is the safe little pieces about my publications, for example.
Hence, my relative silence over the past month, while various significant things have gone unmentioned: During our 4-week visit to the US, my mom fell and broke her foot while we were visiting her in Murray Creek. I flew to Boston for the Humanistic Psychology conference and American Psychological Association conference, where I received the Carl Rogers Award for Contributions to Humanistic Psychology and had a lovely, memorable visit with my famous, fun cousin Courtenay Harding. We moved Kenneth back to his dorm and said goodbye to Brendan and Mayumi as they prepared to leave Cleveland and move to Seattle, Washington. And we brought Diane’s mom, Gladys back to Glasgow with us for a two-week visit. Things started off intensely at work, which huge piles of work waiting for me, papers to grade, exam board, clients, students, ever-mounting pile of email, job interviews, courses starting in new configurations, various crises etc etc.
Part of the issue is that I’ve been run too ragged to write about it, but it is more than that: it wasn’t fun, and I didn’t have any long, unstructured trips during which to just sit and see what comes. I miss that. It's probably inevitable, but it does feel a bit like my running: If I'm too busy to carry on with it, then it means that my life is too busy and something needs to give, period!
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