Title: Person-Centered Science: What We Know and How We Can Learn More about Humanistic/Person-Centered/Experiential Psychotherapies
1Person-Centered Science What We Know and How We
Can Learn More about Humanistic/Person-Centered/Ex
periential Psychotherapies
- Robert Elliott
- University of Strathclyde
2Outline
- Historical Introduction
- Question 1 What have we learned from existing
quantitative research on Humanistic/Person-Centred
/Experiential therapies? - Question 2 What have we learned from existing
qualitative research on Humanistic/Person-Centred/
Experiential therapies? - Question 3 How can we learn more?
3Context Carl Rogers as Psychotherapy Research
Pioneer
- Innovations
- Use of voice recording technology
- Psychotherapy process research
- Controlled outcome research
- Modern process-outcome research
4Humanistic Therapy in Eclipse
- Rogers gave up scientific research when he moved
to La Jolla - Lack of research 1965 - 1990 hurt scientific
academic standing of humanistic therapy - Led to humanistic therapies being marginalized
5Humanistic Therapy Revival
- Since 1990
- Rise of qualitative research
- Re-engagement in quantitative research
- Newer therapies (e.g., Focusing-oriented,
Process-Experiential/Emotion-Focused Therapy,
Pre-therapy) - Available outcome research has tripled
6Current situation
- Danger of split between
- Practitioners and training schools reject
quantitative research in favor of qualitative
research - Small cadre of academic researchers doing
quantitative outcome research in order to gain
official recognition
7Question 1a What Does Positivist Outcome
Research Tell Us?
- Humanistic/Person-Centred/Experiential (HPCE)
meta-analysis project - Meta-analysis analysis of results
- Effect size standardized difference statistic
-
- Creates a common for comparing results
8The HPCE Meta-Analysis Project
- 1st Generation Greenberg, Elliott Lietaer,
1994 (n 36 studies) . - 5th Generation Elliott Freire (2008)
- Supported by a grant from the British Association
for the Person-Centred Approach - 180 studies
- 200 samples of clients
- gt13,000 clients
- 60 controlled studies (vs. no therapy or
waitlist) - 110 comparative studies (vs. HPCE therapies)
9Elliott Freire (2008) Meta-analysis Preliminary
Results
- 1. HPCE therapies associated with large pre-post
client change - Effect size 1.03 sd standard deviation units
- a very large effect
- 2. Clients large posttherapy gains are
maintained over early late follow-ups - Post .95sd gt early follow-up 1.08sd gt late
follow-up (12 months) 1.14
10Elliott Freire (2008) Meta-analysis Preliminary
Results
- 3. Clients in HPCE therapies show large gains
relative to untreated clients - Effect size .81 sd a large effect size
- Proves therapy causes client change.
11Elliott Freire (2008) Meta-analysis Preliminary
Results
- 4. HPCE therapies in general are clinically and
statistically equivalent when compared to other
treatments (combining CBT and other therapies) - Effect size .01 sd
- no difference in amount of change
- Held true even when we only considered randomized
(gold standard) studies
12Elliott Freire (2008) Meta-analysis Results
- 5. Comparison to Cognitive-Behavior Therapy
(CBT) - HPCE therapies as a group slightly but trivially
less effective than CBT - Effect size -.18 sd
- trivially worse (a small effect)
- But
13Elliott Freire (2008) Meta-analysis Results
- 6. Researcher theoretical allegiance effects
strongly predict comparative ES - Correlation between comparative ES and
theoretical allegiance of researcher -.52 - CBT-oriented researchers gt worse effects for
HPCE - Small negative effect for HPCE therapies vs. CBT
disappears after statistically controlling for
researcher allegiance
14Where does researcher allegiance effect come from?
- Big differences in how different HPCE therapies
do in comparison to CBT
Type HPCE Therapy N Comparative ES
Nondirective/ supportive 37 -.36 (worse)
Person-centred 22 -.09 (equivalent)
Emotion-Focused 6 .60 (better)
Other experiential 10 -.14 (equivalent)
15What is Nondirective/ Supportive Therapy?
- Nondirective/supportive
- 87 studies carried out by CBT Researchers (40/46
in total sample) - 65 explicitly labelled as controls (30/46)
- 52 involve non bona fide therapies (24/46)
- 76 of researchers are North American (35/46)
- 61 involve depressed or anxious clients (28/46)
16The Moral of this Story
- We dont have to be afraid of quantitative
research or RCTs - But if we let others define our reality, we are
going to be in trouble. - Therefore, we need to do our own outcome
research including RCTs
17Question 1b What does Quantitative
Process-Outcome Research Tell Us?
- Process-outcome research predicts outcome from
in-therapy process measures, e.g., therapist
empathy - Best-known process variable is Therapeutic
Alliance - Most common measure Working Alliance Inventory
- Meta-analyses show that alliance predicts
outcome e.g., Horvath Bedi, 2002 n 90
studies mean r .21
18Process-Outcome Research on Therapist Empathy
- Therapist empathy is one of the strongest
predictors of outcome - Bohart et al. (2002) meta-analysis
- 47 studies mean r .32
- Accounts for about 10 of the variance in outcome
19Interpretation of r .32
- 1. Optimists view 10 is a lot!
- One of the best predictors of outcome
- Maybe even better that therapeutic alliance
20Interpretation of r .32
- 2. Pessimists view The glass is 90 empty!
- Rogers necessary sufficient predicts
perfect correlation (r 1.0) - r .32 decisively refutes Rogers hypothesis
21Interpretation of r .32
- 3. Optimists rebuttal 10 is almost 100 of
what we can reasonably expect from the real world - Client individual differences in problem severity
and resources predict most of outcome - Measurement error
- Restriction of range (not enough unempathic
therapists!) - Other stuff
22Interpretation of r .32
- 4. Pessimists plea I still want the other 90
23Question 2 What does Qualitative Research Tell
Us?
- Rogers Process Equation was based on
proto-qualitative research - Years of careful observation of productive and
unproductive therapy sessions - Systematic qualitative research is a relatively
recent development - But mature enough now to allow a few small
qualitative meta-analyses
241. Helpful and Hindering Factors
- Greenberg et al. (1994)
- Reviewed 14 studies of HPCE therapies
- Selected 5 most frequent helpful and 3 most
frequent hindering aspects - 14 categories of Helpful aspects, grouped into 4
larger domains
25Most Common Helpful Aspects in HPCE therapies
- 1. Positive Relational Environment (7 out of 14
data sets e.g., empathy) gt - 2. Client's Therapeutic Work (13 sets)
- Most common Self-Disclosure, Involvement gt
- 3. Therapist Facilitation of Client's Work (6
sets e.g., fostering exploration) gt - 4. Client Changes or Impacts (12 sets)
- Most common Understanding/ Insight,
Awareness/Experiencing
26Most Common Hindering Aspects
- Much less common difficult to study
- Most common Intrusiveness/ Pressure
- Even in person-centered therapy
- Also present
- Confusion/Distraction (derailing the client's
process) - Insufficient Therapist Direction
272. Client Post-therapy Changes
- Qualitative outcome
- Jersak, Magana and Elliott (2000 in Elliott,
2002) - 5 studies, mostly Process-Experiential for
depression or trauma
28Jersak et al. (2000)
- Vitalizing the Self Internal change
- 4 subprocesses
- Leaving Distress Behind gt
- Increased Contact with Emotional Self gt
- Improved Self-esteem gt
- Increased Sense of Personal Power/Coping/Self-cont
rol - Describe the first phase of a metaphorical
journey
29Jersak et al. (2000)
- Changes in the Selfs Relationships to
Others/World - 3 subprocesses
- Defining Self with Others/Asserting Independence
- Engaging with Others,
- Experiencing the World More/Mobilizing Self to
Act in the World - Describe the outward phase of the clients
journey
303. Effects of significant therapy events
- Timulak (2007)
- 7 studies, most HPCE
- 9 common categories
- All 7 studies
- Awareness/Insight/Self-Awareness
- Reassurance/Support/Safety
- More than half the studies
- Behavior Change/Problem Solution
- Exploring Feelings/Emotional Experiencing
- Feeling Understood.
31Implication Qualitative Studies of HPCE
- May be possible to integrate these 3 types of
research into a model of HPCE change process - Framework
- Helpful (hindering) aspects gt
- Immediate effects (significant events) gt
- Qualitative outcome
32Question 3 How Can We Learn More?
331. Be Methodologically Pluralist
- Most sensible course of action
- To encourage both kinds of research
- Render politically expedient quantitative data to
the government and professional bodies (Caesar) - Simulaneously carry out qualitative research that
completely honors person-centered principles - Even in the same study
342. Follow Person-Centred Research Principles
- E.g., Mearns McLeod (1984)
- (1) Empathy. Understand, from the inside, the
research participants (client or therapist)
lived experiencing - (2) Unconditional Positive Regard. Accept/prize
the research participants experiencing, - (3) Genuineness. Be an authentic/equal partner
with the research participant participant
co-researcher researcher a fellow human being. - (4) Flexibility. Creatively and flexibly adapt
research methods to the research topic and
questions at hand
35Applying Person-centred principles to different
types of research
- Fairly easy to see application to qualitative
research, e.g., - Clarifying expectations and other researcher
pre-understandings - Negotiating nature of participation with
informant in a transparent, collaborative manner - Carrying out data collection in a careful,
intentional manner, including helping informant
stay focused and clarifying their meanings etc.
36Person-Centred Principles Apply Equally to
Quantitative Research
- Always put the participants needs ahead of yours
- Treating participants disrespectfully and
inconsistently leads to resentment and sloppy,
invalid data - A questionnaire is a form of relationship
37Person-Centred Principles Apply Equally to
Quantitative Research
- A research participant will feel misunderstood
and uncared for by a confusing questionnaire
layout or an overly hot or noisy research room - An ill-prepared research packet or an anxious
interviewer can betray a lack of genuine
commitment by the researcher - All of our criticisms of quantitative research
are really criticisms of bad research, of any kind
383. Focus on Change Process Research
- Much current research on HPCE therapies does not
focus on how change occurs - Needed as complement to outcome research
improve therapy - Select from different genres of change process
research
39a. Important preliminary Basic outcome research
- What are the effects of HPCE therapies with
specific client populations? - Can be quantitative or qualitative
- Single client or group of clients
- Standard questions or individualized
- See Elliott Zucconi (2006) for suggestions to
implement in practice and training settings - Necessary starting point for Change Process
research
40b. Process-Outcome Research
- Quantitative genre Measure process (e.g.,
empathy) gt predict outcome - HPCEs not studied enough with this approach
- Only 6 out of 47 studies in Bohart et al. (2002)
empathy-outcome meta-analysis were HPCE therapies - Highly appropriate to naturalistic samples
41c. Helpful Factors Research
- Qualitative genre
- Interview (e.g., Change Interview)
- Helpful Aspects of Therapy (HAT) Form
- Analyze with variety of methods, e.g., Grounded
Theory, discourse analysis
42d. Micro-analytic Sequential Process Research
- Examine turn-by-turn interaction between client
and therapist - Quantitative client and therapist process
measures (e.g., client experiencing and therapist
empathy) - Qualitative Task analysis or Conversation
analysis
43e. Complex Change Process Research Methods
- Combine genres to develop richer picture
- Balance strengths, limitations
- Examples
- Assimilation Model (Stiles et al., 1990)
- Task Analysis (Rice Greenberg, 1984)
- Comprehensive Process Analysis (Elliott, 1989)
- Hermeneutic Single Case Efficacy Design (Elliott,
2002)
444. Get Involved!
- Elliott Zucconi (2006) International Project
on Psychotherapy and Psychotherapy Training
(IPEPPT) - The project is to stimulate practice-based
research, especial in training centres - Have developed a set of sample research protocols
to choose form
45Further Suggestions (Elliott Zucconi, 2006)
- (1) Contribute to dialogues on how to measure
therapy and training outcomes within HPCE
therapies - (2) Set an example for students and colleagues by
carrying out simple research procedures with your
own clients and in your own training setting - (3) Help to develop specialized research
protocols for particular client populations
(e.g., people living with schizophrenia)
46Further Suggestions (Elliott Zucconi, 2006)
- (4) Contribute to method research aimed at
improving existing quantitative and qualitative
instruments - (5) Take part in more formal collaborations with
similarly-inclined training centers to generate
data for shared research
47- Robert Elliott fac0029_at_gmail.com
- Blog pe-eft.blogspot.com