An International Project on the Effectiveness of Psychotherapy and Psychotherapy Training (IPEPPT): Research Framework and Protocols Robert Elliott University of Toledo - PowerPoint PPT Presentation

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An International Project on the Effectiveness of Psychotherapy and Psychotherapy Training (IPEPPT): Research Framework and Protocols Robert Elliott University of Toledo

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Title: An International Project on the Effectiveness of Psychotherapy and Psychotherapy Training (IPEPPT): Research Framework and Protocols Robert Elliott University of Toledo


1
An International Project on the Effectiveness of
Psychotherapy and Psychotherapy Training
(IPEPPT) Research Framework and Protocols
Robert ElliottUniversity of Toledo
2
Research-Practice Gap in Era of Evidence-Based
Mental Health
  • Numerous contemporary attempts to link research
    practice in psychotherapy
  • Top-down solutions
  • Empirically-supported treatments
  • Evidence-Based Practice
  • Based on
  • Randomized Clinical Trials research model
  • Therapist-as-research-consumer model
  • Results have been mixed

3
Research-Practice Integration as a Two-way,
Dialectic Process
  • Success is more likely if we add a more
    integrative, bottom-up strategy
  • Building on Mental Health Services/ Therapy
    Effectiveness paradigm
  • Existing RCT research makes space for
    grass-roots-based research in real world practice
    and training settings
  • Practice-based Evidence

4
Example Practitioner Research Networks (PRNs)
  • USA Pennsylvania (Ragusea, Borkovec, Castonguay)
  • UK National Health Service CORE research team
    (Barkham, Evans et al.)
  • Latest trend Practice-based research in training
    clinics and centers (e.g., Castonguay et al.)

5
Practice-Based Therapy Research in Training Sites
  • Training site research movement USA, Europe
  • Research on psychotherapy process/outcome is
    essential for understanding and improving
    psychotherapy practice in all orientations
  • Being able to use and carry out research is an
    important aspect of therapist competence
  • Best way to learn therapy research methods
  • Do research during basic therapy training
  • Primary professional socialization process
  • Create habits that carry over into later practice

6
Principles for Practice-based Research
  1. Make research relevant to actual practice of
    therapy
  2. Use methods that support therapy rather than
    interfere with it
  3. Actively and continuously involve therapists in
    selection of research questions and methods
  4. Include inexpensive and easy-to-use instruments
    of key elements (therapeutic alliance, client
    problem severity)
  5. Encourage variety of research methods
    (qualitative quantitative group single-case)
  6. Create research networks of training sites using
    similar, pan-theoretical instruments

7
International Project on the Effectiveness of
Psychotherapy and Psychotherapy Training (IPEPPT)
  • Formally initiated, June 2004, by
  • Italian Coordinamento Nazionale Scuole di
    Psicoterapia (CNSP gt5,000 therapists)
  • Italian Federation of Psychotherapy Associations
    (FIAP 21 psychotherapy associations gt10,000
    therapists)
  • General Goal To improve psychotherapy and
    psychotherapy training in a broad range of
    theoretical approaches by encouraging systematic
    research in therapy training institutes and
    university-based training clinics.

8
IPEPPT General Scientific Steering Committee
  • Robert Elliott, Scientific Director (University
    of Toledo-USA)
  • Alberto Zucconi, Coordinator (University of
    Siena-Italy)
  • David Orlinsky (University of Chicago-USA)
  • Franz Caspar (University of Freiburg)
  • Louis Castonguay (Pennsylvania State
    University-USA)
  • Glenys Parry (University of Sheffield-UK)
  • Bernhard Strauss (Friedrich Schiller University
    Jena-Germany)

9
IPEPPT Current Status
  • Still in formation stage
  • Not a single study
  • The Project Promoting practice-based research
    in Europe, North American and elsewhere
  • Finding partners
  • Creating/finding tools
  • E.g., conceptual/organizing concepts

10
IPEPPT Specific Objectives
  • 1. To construct a list of agreed-upon general
    pantheoretical recommendations for evaluating
  • Key aspects of therapy, especially in training
    centers
  • Key aspects of therapy training outcome
  • Not a Core Battery
  • 2. To facilitate the development of specific
    treatment and training outcome protocols for
    particular
  • Therapy approaches (e.g., Systemic therapy)
  • Client populations (e.g., people living with
    schizophrenia)
  • Linguistic/national groups (e.g., Italy)
  • 3. To facilitate national/international
    collaborations

11
IPEPPT Draft Research Framework
  • Such a project requires a guiding conceptual
    framework for determining what to measure and how
    to measure it
  • Work-in-progress
  • 8 measurement domains
  • 4 Research themes
  • 2 Levels (Star design)

12
Framework Eight Therapy Measurement Domains,
with examples of key concepts
Research Theme A. General/ Pantheoretical B. Treatment- Specific
I. Therapy Outcome e.g., general problem severity e.g., theory-based dysfunctional processes
II. Therapy Process e.g., therapeutic alliance e.g., therapist techniques
III. Client/Ther-apist Background e.g., demographics e.g., preference for type of therapy
IV. Training Outcome e.g., productive vs. unproductive practice pattern e.g., therapist skill development
13
Structure (1) Star Design
  • Main body of the star General outcome/ process
    protocol
  • Shared by all orientations (General/
    Pantheoretical)
  • Provides common metric
  • Star rays Specialized protocols for different
    therapy approaches and different countries
    (Treatment/Population/Language Specific)

14
Star Design for Sample Concepts within Therapy
Outcome Domain for Studies of Four Different
Therapies
15
Structure (2) Nested Priority Lists
  • Not a single core battery
  • Allow flexibility while encouraging consistency
    within across approaches
  • Three Levels of Priorities
  • Measurement domains are prioritized
  • Within each measurement domain, key concepts are
    ranked by approximate importance
  • For each concept, available instruments are also
    described (researchers prioritize)

16
Framework Eight Therapy Measurement Domains,
with examples of key concepts
Research Theme A. General/ Pantheoretical B. Treatment- Specific
I. Therapy Outcome e.g., general problem severity e.g., theory-based dysfunctional processes
II. Therapy Process e.g., general problem severity e.g., therapist techniques
III. Client/Ther-apist Background e.g., demographics e.g., preference for type of therapy
IV. Training Outcome e.g., productive vs. unproductive practice pattern e.g., therapist skill development
17
Example General Therapy Outcome Domain
  • Key concepts in a possible recommended priority
    order (Star)
  • (1) General problem severity (quantitative)
  • Give every 2 sessions to reduce data loss from
    drop-out
  • (2) Interpersonal/relational functioning
  • (3) Qualitative perceptions of change
  • (4) Individualized problems/goals
  • (5) Health care utilization/costs
  • (6) Quality of life/life satisfaction/well-being

18
Common General Symptom Severity Instruments
19
Framework Eight Therapy Measurement Domains,
with examples of key concepts
Research Theme A. General/ Pantheoretical B. Treatment- Specific
I. Therapy Outcome e.g., general problem severity e.g., theory-based dysfunctional processes
II. Therapy Process e.g., therapeutic alliance e.g., therapist techniques
III. Client/Ther-apist Background e.g., demographics e.g., preference for type of therapy
IV. Training Outcome e.g., productive vs. unproductive practice pattern e.g., therapist skill development
20
Example General Therapy Process Domain
  • Key concepts in possible recommended priority
    order
  • (1) Therapeutic alliance
  • (2) Therapist and client response modes
  • (3) Perceived helpful aspects of therapy
  • (4) Perceived session effectiveness

21
(No Transcript)
22
Different Levels of Research Protocol are Possible
  • I. Minimum Protocol
  • II. Systematic Case Study Protocol
  • III. Maximum Protocol
  • Other Protocols
  • IV. General Training Protocols
  • V. Specific Research Protocols

23
I. A Recommended Minimum Protocol Applications
  • Easy to use Limited to one measure from each of
    the first three research domains
  • Can use with own clients
  • Provides basic treatment monitoring for
    individuals agencies
  • Other versions are possible (e.g., different
    outcome or process measures)

24
I. A Recommended Minimum Protocol Elements
  • (1) General therapy outcome instrument
  • Client problem severity
  • Give at odd-numbered sessions (short form)
  • (2) General therapy process
  • Therapeutic alliance (use short from)
  • (3) Client/therapist background measure
  • Standard practice
  • Client/ therapist demographics
  • Client diagnosis, presenting problems
  • Type of therapy

25
II. Systematic Case Study Protocol Applications
  • Use for student case study requirements
  • Meets emerging standards for systematic single
    case research
  • New online journal Pragmatic Case Studies in
    Psychotherapy (Rutgers University, Editor
    Fishman)

26
II. Systematic Case Study Protocol Elements
  • A. Therapy Outcome
  • (1) Weekly/biweekly outcome measure
  • (2) At least one other quantitative outcome
    measure
  • (3) Qualitative outcome assessment (e.g.,
    post-therapy interview)
  • B. Therapy Process
  • (1) Therapeutic alliance
  • (2) Detailed record of therapy (process notes
    and/or recordings)
  • (3) Qualitative perception of helpful aspects
    (post-session and/or post-therapy)
  • C. Client/therapist background
  • Client/ therapist demographics client diagnosis,
    presenting problem type of therapy

27
II. Systematic Case Study Protocol Research
Questions
  • (1) Did the client change substantially over the
    course of therapy?
  • (2) If the client changed, did therapy make a
    substantial contribution?
  • (3) What brought about the clients changes?

28
II. Systematic Case Study Protocol Emerging
Evidence Standards
  • (1) Rich case record, including both quantitative
    qualitative data
  • (2) Replication/convergence across methods
  • (3) Critical examination of alternative views
    (e.g., Hermeneutic Single Case Efficacy Design,
    Elliott, 2002)
  • Non-change explanations (e.g., measurement error)
  • Non-therapy explanations (e.g., extra-therapy
    events)
  • (4) Narrative coherence
  • Narrative model of predisposing and process
    factors
  • Use for generalizing to other cases

29

III. Maximum Protocol
  • Include measures of at least one concept in each
    of the eight domains
  • Appropriate for research centers (e.g., Center
    for the Study of Experiential Psychotherapy)
  • Also consortia of cooperating centers
  • Each center measure some variables

30
IV. General Training Research Protocols Issues
  • Outcomes of therapy training not well understood
  • Difficulties
  • Lack of agreed-upon measures of therapist
    functioning and skill
  • Must measure therapist change longitudinally over
    several years of training
  • Possible applications
  • Use research to improve training
  • Meet requirements of accrediting and funding
    agencies

31
IV. General Training Research Protocols
Promising Concepts
  • General therapist facilitative interpersonal
    skills (e.g., coping with common difficulties)
  • Quality of therapist professional involvement and
    growth (e.g., Orlinsky Collaborative Research
    Network CRN)
  • Qualitative perceptions of effects and important
    aspects of training (e.g., qualitative
    interviews)
  • Change in therapist self concept (e.g., Scilligo,
    SASB Introject scales)

32
V. Specific Protocols
  • Star rays
  • Applications For specific theoretical
    approaches, client populations, or language
    groups
  • Requires working committee for each group
  • Identify relevant therapy outcomes, processes,
    background variables (or training outcomes)
  • Do protocol and measure development research
  • Establish virtual communities for exchanging ideas

33
V. Specific Protocol Example
  • Person-Centered and Experiential Psychotherapy
    International Research Group (PCEP-IRG)
  • Current core members
  • University of Toledo (Elliott team)
  • Ohio University (Anderson team)
  • Katholieke Universiteit Leuven (Leijssen team)
  • Universities of Strathclyde Abertay, Scotland
    (McLeod, Cooper)

34
V. PCEP-IRG Outcome Protocol Promising
Developments
  • Center for the Study of Experiential Therapy
    Research Protocol (CSEP- 2)
  • Self--determined problems/goals
  • Personal Questionnaire (PQ-10)
  • Self-concept (content coherence)
  • Qualitative Self-Description interview
  • Tennessee Self-Concept Scale 2 (long, short
    forms)
  • Experiential processing
  • Toronto Alexithymia Scale (TAS-20)
  • Need positive mental health measures,
    self-coherence, etc.

35
V. Specific Training Research Protocols
  • Some Possible Types of Specific Training
    Outcomes
  • Treatment-specific intervention skill
  • Case formulation skill
  • Therapist personal development (e.g., maturity,
    identification with orientation, values)

36
Promising New Therapy Research Methods Make this
Work Possible
  • Systematic qualitative research methods
  • Interpretive single case designs (Fishman,
    Elliott)
  • Using early outcome to identify repair problems
    (Lambert Signal alarm methods)
  • New, powerful psychometric methods (Rasch
    analysis/Item Response Theory)
  • Virtual communities (Community Zero)

37
Invitation to Dialogue - 1
  • 1) Provide comments and suggestions on the
    framework concepts presented here
    Robert.Elliott_at_utoledo.edu
  • 2) Form or join online discussion groups or
    virtual communities
  • Closed sites must apply for membership
  • General info www.communityzero.com/ipeppt
  • Example www.communityzero.com/pcepirp
  • 3) Begin implementing the minimum protocol design
    with your own clients and in your own training
    setting.

38
Invitation to Dialogue - 2
  • 4) Convert traditional case presentation training
    requirements into systematic case study exercises
  • 5) Help with translations of key research
    instruments
  • 6) Contribute to psychometric research
  • Improve existing instruments
  • Equate different instruments for same concepts
  • 7) Collaborate with groups with similar interests
    to generate data for pooling.
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