Person-Centered Science:
What We Know and How
We Can Learn More about
Humanistic/Person-Centered/Experiential
Psychotherapies
Robert Elliott
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?
Context: Carl Rogers as
Psychotherapy Research
Pioneer
Innovations:
Use of voice recording technology Psychotherapy process research Controlled outcome research
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
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)
Current situation
Danger of split between:
Practitioners and training schools: reject quantitative research in favor of qualitative research
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
Change E.S. = m
pre
− m
post
sd
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
>13,000 clients
60 controlled studies (vs. no therapy or waitlist)
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
Elliott & Freire (2008)
Meta-analysis Preliminary Results
3.
Clients in HPCE therapies show
large gains relative to untreated
clients
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
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 sdElliott & 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 => worse effects for HPCE
Small negative effect for HPCE therapies vs. CBT disappears after statistically
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)
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)
The Moral of this Story:
We don’t 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
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
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
Interpretation of r = .32
1. Optimist’s view: 10% is a lot!
One of the best predictors of outcome
Interpretation of r = .32
2. Pessimist’s view: The glass is 90%
empty!
Rogers’ “necessary & sufficient” predicts perfect correlation (r = 1.0)
Interpretation of r = .32
3. Optimist’s 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!)
Interpretation of r = .32
4. Pessimist’s plea: I still want the other
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
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,
Most Common Helpful
Aspects in HPCE therapies
1. Positive Relational Environment (7 out of
14 data sets; e.g., empathy) =>
2. Client's Therapeutic Work (13 sets)
Most common : Self-Disclosure, Involvement =>
3. Therapist Facilitation of Client's Work (6
sets; e.g., fostering exploration) =>
4. Client Changes or Impacts (12 sets)
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)
2. Client Post-therapy
Changes
Qualitative outcome
Jersak, Magana and Elliott (2000; in
Elliott, 2002)
5 studies, mostly Process-Experiential
Jersak et al. (2000)
Vitalizing the Self: Internal change
4 subprocesses:
Leaving Distress Behind =>
Increased Contact with Emotional Self =>
Improved Self-esteem =>
Increased Sense of Personal Power/Coping/Self-control
Jersak et al. (2000)
Changes in the Self’s 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
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
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 =>
Immediate effects (significant events) =>
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
2. Follow
Person-Centred Research
Principles
E.g., Mearns & McLeod (1984)
(1) Empathy. Understand, from the inside, the research participant’s (client or therapist) lived experiencing
(2) Unconditional Positive Regard. Accept/prize the research participant’s experiencing,
(3) Genuineness. Be an authentic/equal partner with the research participant: participant = co-researcher; researcher = a fellow human being.
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;
Person-Centred Principles
Apply Equally to
Quantitative Research
Always put the participant’s needs
ahead of yours
Treating participants disrespectfully and
inconsistently leads to resentment and
sloppy, invalid data
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
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
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
b. Process-Outcome
Research
Quantitative genre: Measure process
(e.g., empathy) => predict outcome
HPCE’s not studied enough with this
approach:
Only 6 out of 47 studies in Bohart et al. (2002) empathy-outcome meta-analysis were HPCE therapies
c. Helpful Factors
Research
Qualitative genre:
Interview (e.g., Change Interview)
Helpful Aspects of Therapy (HAT) Form Analyze with variety of methods, e.g.,
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
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)
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
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
Further Suggestions
(Elliott & Zucconi, 2006)
(4) Contribute to method research aimed at
improving existing quantitative and qualitative instruments
