Person-Centered Science: What We Know and How We Can Learn More about Humanistic/Person-Centered/Experiential Psychotherapies - PowerPoint PPT Presentation

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Person-Centered Science: What We Know and How We Can Learn More about Humanistic/Person-Centered/Experiential Psychotherapies

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Title: Person-Centered Science: What We Know and How We Can Learn More about Humanistic/Person-Centered/Experiential Psychotherapies


1
Person-Centered Science What We Know and How We
Can Learn More about Humanistic/Person-Centered/Ex
periential Psychotherapies
  • Robert Elliott
  • University of Strathclyde

2
Outline
  • 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?

3
Context Carl Rogers as Psychotherapy Research
Pioneer
  • Innovations
  • Use of voice recording technology
  • Psychotherapy process research
  • Controlled outcome research
  • Modern process-outcome research

4
Humanistic 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

5
Humanistic 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

6
Current 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

7
Question 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

8
The 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)

9
Elliott 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

10
Elliott 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.

11
Elliott 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

12
Elliott 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

13
Elliott 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

14
Where 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)
15
What 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)

16
The 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

17
Question 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

18
Process-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

19
Interpretation of r .32
  • 1. Optimists view 10 is a lot!
  • One of the best predictors of outcome
  • Maybe even better that therapeutic alliance

20
Interpretation 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

21
Interpretation 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

22
Interpretation of r .32
  • 4. Pessimists plea I still want the other 90

23
Question 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

24
1. 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

25
Most 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

26
Most 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

27
2. Client Post-therapy Changes
  • Qualitative outcome
  • Jersak, Magana and Elliott (2000 in Elliott,
    2002)
  • 5 studies, mostly Process-Experiential for
    depression or trauma

28
Jersak 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

29
Jersak 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

30
3. 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.

31
Implication 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

32
Question 3 How Can We Learn More?
33
1. 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

34
2. 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

35
Applying 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.

36
Person-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

37
Person-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

38
3. 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

39
a. 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

40
b. 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

41
c. 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

42
d. 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

43
e. 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)

44
4. 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

45
Further 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)

46
Further 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
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