Person-centred science: what we know and how we can learn more about experential-humanistic psychotherapies

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(1)

Person-Centered Science:

What We Know and How

We Can Learn More about

Humanistic/Person-Centered/Experiential

Psychotherapies

Robert Elliott

(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?

(3)

Context: Carl Rogers as

Psychotherapy Research

Pioneer

Innovations:

Use of voice recording technology Psychotherapy process research Controlled 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

(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)

(6)

Current situation

Danger of split between:

Practitioners and training schools: reject quantitative research in favor of qualitative research

(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

Change E.S. = m

pre

− m

post

sd

(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

>13,000 clients

60 controlled studies (vs. no therapy or waitlist)

(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

(10)

Elliott & Freire (2008)

Meta-analysis Preliminary Results

3.

Clients in HPCE therapies show

large gains relative to untreated

clients

(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

(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

(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 => worse effects for HPCE

 Small negative effect for HPCE therapies vs. CBT disappears after statistically

(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)

(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)

(16)

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

(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

(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

(19)

Interpretation of r = .32

1. Optimist’s view: 10% is a lot!

One of the best predictors of outcome

(20)

Interpretation of r = .32

2. Pessimist’s view: The glass is 90%

empty!

 Rogers’ “necessary & sufficient” predicts perfect correlation (r = 1.0)

(21)

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!)

(22)

Interpretation of r = .32

4. Pessimist’s plea: I still want the other

(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

(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,

(25)

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)

(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)

(27)

2. Client Post-therapy

Changes

Qualitative outcome

Jersak, Magana and Elliott (2000; in

Elliott, 2002)

5 studies, mostly Process-Experiential

(28)

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

(29)

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

(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

(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 =>

Immediate effects (significant events) =>

(32)
(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

(34)

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.

(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;

(36)

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

(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

(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

(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

(40)

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

(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.,

(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

(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)

(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

(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

(46)

Further Suggestions

(Elliott & Zucconi, 2006)

(4) Contribute to method research aimed at

improving existing quantitative and qualitative instruments

(47)

Robert Elliott:

fac0029@gmail.com

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References

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