ISSN 1359-3706
Feedback greatly appreciated: Email [if your HTML browser doesn't support "mailto:" then use a mail package and send to: C.Evans@sghms.ac.uk]
This year SPR(UK) is not holding a residential conference at Ravenscar, as we are hosting the International Meeting at York in the summer (28th of June to the 2nd of July - see elsewhere in this issue). However, we are going to hold a one-day conference entitled "BRIEF THERAPIES AND EVALUATION IN THE N.H.S." at the Uffculme Clinic, Birmingham, on Friday the 18th of March 1994.
The fee will be £25 (members) and £40 (non-members) and the conference will include research papers and service evaluation items.
Glenys Parry, who now works at the Department of Health as well as in the District Clinical Psychology service in Sheffield, will be giving an opening address entitled "Brief Psychotherapy: who needs it?" in which she will discuss the effect of market forces on psychotherapy and the dangers thereof.
All submissions, either for the research or the clinical audit and evaluation sections, must be in to their respective coordinators by December 31st 1993.
General enquiries and requests for application forms should be made to:
Ms. Debra Kirby [address removed to prevent confusion]Abstracts of research submissions should be sent to:
Dr. Rex Haigh [address removed to prevent confusion]Abstracts of service evaluation and audit submissions should be sent to:
Mary Burton [address removed to prevent confusion]Rex Haigh [Page 1 in printed version] [return to index]
The 1994 International Conference will be held at the University of York, an attractive landscaped campus two miles from the centre of York. York with the beautiful Minster and surrounding medieval walls provides a delightful setting for the Society's meeting next year. There are also excellent rail and road links with all parts of the country and there is a direct train service from Manchester International Airport.
The Conference Banquet will be held at Ripley Castle. At the reception before the dinner members will be able to look round the castle and terrace.
Pre and Post Conference visits have been arranged, including Castle Howard and the Yorkshire Dales.
Accommodation will be available either at the University of York or hotels in York.
Further details including a full programme will be available after the final international organising meetings in January from:
SPR Conference Secretariat, Bell Howe Conferences, 1 Willoughby Street, Beeston, Nottingham NG9 2LT Tel.: 01602 436323 [left in only as I felt they deserved the advertising]Last minute submissions are still possible as the closing date is Wednesday the 15th of December. All submissions should be sent to:
Clara E. Hill, Ph.D. [address removed to prevent confusion]Michael Barkham [Page 2 in printed version] [return to index]
I have taken over the rôle of editor from Michael Barkham which has contributed to the rather late distribution of this edition: another reason for me to appreciate his efforts and achievements over the past few years and something that gives an added note of sincerity to my thanks to him. I hope I'll be able to follow on from his work. In future I will try to make sure that an edition, however small, goes out with the International mailings twice a year. I'd really like as many submissions as possible all the time but this scheduling means that you should think in terms of one edition coming out somewhere around May and the other around September/October.
This edition we have articles by Glenys Parry on the task group on assessing therapists' psychodynamic competence and the developments in that work since Ravenscar. That encouraged me to include a small piece on the developments of U.K.C.P. and their possible implications for psychotherapy research and we have a commentary on the Mental Health Foundation two day, invitation only, conference on "Research Foundations for Psychotherapy Services" from which I gather Mark Aveline is editing a book of the proceedings. (see next issue). With a little encouragement, Shirley Reynolds has provided a though-provoking commentary which will, I hope , encourage others to submit such pieces in future.
One thing I want to initiate is some book reviews looking at books in terms of what they may or may not have to offer psychotherapy researchers. Books that are available are:
[HTML readers. As of 24.iv.95 the italicised books have been snapped up (though not necessarily reviewed yet!). If you would like to do either of the other two then please read on!]
I know from past experience that you only get reviews on a small proportion of books you send out so I'm going to be ruthless: send me a cheque for the value of the book made out to "St. George's Hospital Medical School, MHGP RNFB account" and I'll send you the book. When I receive the review it will be published and you'll get your money back (sadly I don't think the Medical School will pass on the interest it gets on the money to me!) A few reviewers locally are already beavering away on a few books and if you feel a particular book you've read is worthy comment send it here. If you want a book that is not on the list to review then leave the name of the author, the title and the publisher (and ISBN number and telephone and/or fax number for the publisher if you can get them) and I'll try to get you a copy (usual cheque requirement will still apply if I succeed in wheedling a review copy out of the publisher.
Brief reviews of papers you think are important will also be very gratefully received as I suspect that most of us would much appreciate some pre-processing of the unmanageable volume that is published weekly. Papers that have been published in journals other than the mainstream psychotherapy journals but which seem pertinent are particularly helpful and I'm very happy to provide a sort of correspondence column for journals which publish psychotherapy research papers but don't carry correspondence (and perhaps reject your perceptive rebuttal or counter-attacking article when you submit it to them!)
Submissions can be sent to me by mail at:
Section of Psychotherapy, Dept. of Mental Health Sci., St. George's Hosp. Med. Schl,, Cranmer Terrace, London SW17 0REby fax to 081-725 2540 or by JANET to C.Evans@sghms.ac.uk (for those who know what this means! - more next issue)
Chris Evans Email : ME! [if your HTML browser doesn't support "mailto:" then use a mail package and send to: C.Evans@sghms.ac.uk] [Pages 2 to 3 in printed version] [return to index]
The aim of this mental health foundation sponsored conference was to promote research activity in psychotherapy. In the presence of an invited audience a range of highly influential and high status psychotherapy researchers were invited to consider how their own research and experience might faciltate current and future research into psychotherapy. The speakers were well selected, representing good North American research (Ken Howard, Robert Elliott and Varda Shoham) and good British research (e.g. Ivy Blackburn, David Shapiro and Paul Salkovskis), and for the most part attended to important theoretical and methodological issues in research as well as attending to the process of actually doing psychotherapy research.
It was this attention to the process of doing research that most impressed me. For example, Robert Elliott presented an extremely helpful overview of process research and paid specific attention to the practical problems of doing psychotherapy process research in clinical (as opposed to research) settings. He discussed how it is possible to use single case studies in an informative way and how clinicians can begin to introduce process measures into their clinical practice in a non-intrusive way. In addition he drew our attention to the essential (but often faulty) relationship between clinicians and researchers and suggested positive ways of enhancing this relationship. Gillian Hardy addressed the doing of psychotherapy research from a different perspective: that of the organizational constraints that can so often obstruct or prevent the implementation of well-considered, theoretically important and clinically relevant research. Her paper illuminated some common organizational resistances to research and, even more importantly, provided a framework for understanding organizational obstacles to research and made helpful suggestions on how these obstacles may be overcome.
From the perspective of psychotherapy outcome the field was well represented. Ken Howard presented the outcome of a naturalistic study of 197 clients. Clinical state is assessed through treatment and these assessments are used both as outcome measures and as a form of feedback to therapists about the progress of their clients. David Shapiro used the more controlled Sheffield Psychotherapy Project to illustrate how outcome research might be adapted to suit the constraints of clinical practice. Attention was also given to the treatment of specific conditions such as panic disorder (Paul Salkovskis) and post traumatic stress disorder (James Thompson) and the longer term effects of sexual abuse in childhood (Judith Trowell).
The presenters, then were on the whole, well selected. However, the aim of this conference was to promote discussion and exchange between the presenters and the audience and it was at this point that it fell short. Although some attempt was given to allocate time for discussion around the formal presentations, this time was inadequate. This is a common problem in all conferences. A more serious problem from the point of view of debate, discussion and progress of research was the selection of the invited audience. It is unclear what criteria were used, but there was an over-representation of senior academic psychiatrists with peripheral involvement and interest in psychotherapy research. As is so often the way, these senior but peripheral members of the audience dominated the final and most extended discussion. This might not matter except that their understanding of psychotherapy research appeared to have stopped after they read Eysenck's 1952 critique of psychotherapy outcome research. Thus discussion was dominated by concerns that psychotherapy should continue to demonstrate effectiveness in the context of controlled trials. In this atmosphere issues concerning psychotherapy process were ignored as were any advances that psychotherapy research has made in forty years. There were important and exciting new developments discussed at this conference; unfortunately the final discussion which will form part of an edited book of proceedings does not reflect these.
A final note of discomfort that I experienced was the uneasy contrast between being the guest of the Mental Health Foundation which involved being fed and accommodated extremely well for two days while being aware that this was financed by a charitable body. At the conference dinner, whilst we digested our five course meal and sampled the contents of the college wine cellar, the Mental Health Foundation's director, June McKerrow, described to us just how difficult it was to raise money for mental health research. Apparently 50% of the MHF's budget is used to support research in mental health; I hope we didn't consume most of it during our two-day conference!
Shirley Reynolds (Research Clinical Psychologist) [Pages 4 to 5 in printed version] [return to index]
Those of you who were at Ravenscar this year will have heard of the task group which tackled a difficult subject - how can we, as therapists, trainers and researchers, assess the competence of psychodynamic therapists? The conference task group, facilitated by Mark Aveline, Frank Margison and Glenys Parry, worked very hard. After an introductory session, the group brainstormed around elements of psychodynamic competence in terms of three categories.
First, the therapist draws on a knowledge base and critical understanding of a range of areas. These include child development, the nature of unconscious processes, defence mechanisms, object relations and transference phenomena, a consistent psychodynamic model and the ability to formulate problems by integrating theory and practice.
Second, the therapist has a level of personal knowledge, is able to use information about the self in relation to the client in a systematic way. This includes personal understanding of countertransference, the internal world of the therapist, the internal supervisor, the therapist's contribution to acting in and bad practice.
Third, the therapist has acquired some demonstrable clinical skills. These include providing and maintaining therapeutic space, developing shared meanings with the client, making appropriate and timely interventions, providing structure and containment, and fostering a therapeutic alliance.
This is by no means an exhaustive list of all the areas which emerged in the group, but it gives the flavour of the exercise. Each of these elements was "unpacked" into more specific exemplars. After this, the group went on to attempt to demonstrate how such competencies could be assessed, both for those completing training and those in continuing professional development. In the short time available only three topics were analysed in detail, one from each of the domains above; the ability to develop a formulation which predicts core dynamics, the understanding and appropriate use of countertransference and the ability to make appropriately timely interventions.
After the group, the three facilitators drew up a consensus statement which each participant received and which was presented to the conference plenary. Later in the year, the same Aveline-Margison-Parry trio presented some of this work to a workshop held at the Tavistock Clinic on "Psychotherapy training in a changing world". This sparked a stimulating discussion and many thoughtful points were raised.
Some members may be aware that the Department of Employment sponsored "National Council for Vocational Qualifications Lead Body on Advice, Guidance and Counselling" (pause for breath!) has recently commissioned a very quick report on whether or not it would be feasible to include psychotherapy in the remit of the lead body. The consultants have given a cautious go-ahead to the idea. Their approach differs from the S.P.R. or profession-led approach considerably, particularly in their reliance on functional mapping which many feel neglects the therapist's knowledge base and the importance of research evidence in understanding competence. In this context, it seems particularly important to continue to develop our thinking on these complex issues, not least to prevent an over-simplistic mapping of the field failing to do justice to the skills and knowledge needed for good psychodynamic therapy.
Mark, Frank and Glenys have now set themselves the task of writing up this work for publication, reviewing the background issues, taking the consensus statement from the group, incorporating comments from the trainers' day and those of other S.P.R. colleagues. They are very happy to send a draft of this paper, when it is ready, to any S.P.R. member expressing an interest. All help will be acknowledged! Please write to Dr. Glenys Parry, Argyll House, Williamson Road, Sheffield, S11 9AR or 'phone 0114 271 6310.
Glenys Parry [Pages 4 to 5 in printed version] [return to index]
Not all S.P.R. members will necessarily be aware that the United Kingdom Standing Conference for Psychotherapy (UKSCP) dropped its "S" and changed its "C" on the 10th of January this year and became the United Kingdom Coucil for Psychotherapy however I assume that most know that on the 20th of May its Register of Psychotherapists was presented in the House of Lords. This represents a fairly substantial development for psychotherapy in this country. UKCP now has a newsletter, edited by Tom Chamberlain, and a home at:
Regent's College,This also means that psychotherapists whose name appears in the register may now style themselves "U.K.C.P. Registered [label under which coded in the register] Psychotherapist" e.g. U.K.C.P. Registered Existential Psychotherapist" and it clearly could do the future of British psychotherapy and British psychotherapy research a power of good. I have excerpted some points which seem particularly relevant to psychotherapy research from the initial presentation address by the Chair of the U.K.C.P., Dr. Emmy van Deurzen-Smith (I recommend reading the whole text in the British Journal of Psychotherapy (1993) 9(4):513-517).
Now that the Register is under way, the U.K.C.P. can begin to pay attention to some neglected areas. It is launching a newsletter and will begin to organise national and international conferences and other events. It has already taken the initiative of organising a regular "Academic Forum" which brings together all academic departments that run psychotherapy-related courses in the U.K. We are currently witnessing an explosive growth of university-based courses in psychotherapy, and it is desirable both for these new courses and for the established psychotherapy trainings that standards and other issues of common concern are monitored from the outset. Some of these university courses have already achieved membership of U.K.C.P. and others are in the process of applying. [p. 514]
It is a great comfort to those of us who have to settle these issues that the government has now stepped in to mediate in this dispute [refers to disputes surrounding the withdrawal from the U.K.C.P. process of the British Psycho-Analytical Society on one hand, and the British Association of Counselling on the other]. The established Lead Body for Advice, Guidance and Counselling [see article on the Ravenscar Conference Workshop by Glenys Parry] has now been briefed by the Department of Employment to include the occupational mapping of psychotherapy. This process will lead to the establishment of National Vocational Qualifications up to level five (postgraduate professional level) for the whole sector. What this means is that there will be a national programme of audit for the whole discipline of counselling and psychotherapy which will lead to the recognition of the competencies on which those professions are base, as they are currently practised.
This in effect will present us with a differentiation project that will establish an official terminology and stratification of the entire field, including that of its training components and internal equivalences. This project is obviously capable of revolutionising the profession (or professions) as we know them. It is crucial for us to be extremely watchful and cautious of the way in which this project is carried out. U.K.C.P. has played an active role in the run-up to the project and and will be closely involved in the work of the Lead Body throughout the project and beyond. If our internal battles had held us up any longer, psychotherapy would not have had any such direct representation at all, and the field would have altered unrecognisably whilst we were bickering away with each other in our separate corners. [p. 516]
U.K.C.P. will do its utmost to defend the interests of all the professionals it represents. The first Register will include well over 3,000 names and this will increase rapidly over the next few years. As a united organisation we can have a tremendous influence on national developments and a considerable impact on the creation of structures in the European Economic Area and beyond that to the Eastern Bloc. The opportunities ahead are manifold and great. As an emerging united profession we are ready to face them and utilise them to the best of our abilities. [concluding paragraph, p.517]
With my S.P.R. hat on pertinent bits of the "Entry Requirements, Curriculum Contents and Requirements of Training Courses" caught my eyes:
1. Entry requirements
1.1. Entry is at a postgraduate level of competence.
...
2. The mimimum curriculum
...
2.2. Acquisition of a critical understanding of the relevance of studies in human development, psychopathology, sexuality, ethics, research and social science.
...
3. Basic requirements of Training Courses
3.1. The training shall be at postgraduate level. [italics in the original]
...
I was also relieved to see that at least some explicit consideration seemed to have been given to the need for psychotherapy research as these points from the "Ethical Guidelines" show.
2.7. Research: Psychotherapists are required to clarify with clients the nature, purpose and conditions of any research in which the clients are to be involved and to ensure that informed and verifiable consent is given before commencement. [stress in the original]
2.8. Publication: Psychotherapists are required to safeguard the welfare and anonymity of clients when any form of publication of clinical material is being considered and to obtain their consent whenever possible.
I suspect that the position of psychotherapy research within the thinking of the U.K.C.P. is something that we within S.P.R. should consider carefully. Rumour has it that Professor Digby Tantum of Warwick University is coordinating the creation of a body of university trainings in psychotherapy but I was unable to contact him to get a small piece to describe that fascinating development (hint for next edition Digby!) and I'm not sure how many people interested in psychodynamic psychotherapy in higher education know of T.H.E.R.I.P.: The Higher Education Research and Information Network in Psychoanalysis who organise interesting talks (largely in London so far?) publish a newsletter rather more beefy than our very own little NETWORK and also a very interesting annual register of members and their declared interests. I'll quote from their latest register for those who are interested:
To join THERIP, send a cheque for £20.00 (payable to THERIP; £8.00 for students and unwaged, £35.00 institutional membership) to Audrey Cantlie, 5 Upper Wimpole Street, London W1M 7TD.
Chris Evans [Pages 7 to 8 in printed version] [return to index]
Please pick up the 'phone now and ring Dr. Jane Knowle's secretary, Sue Clarke on:
01734 569444
and remedy the situation. Then put an abstract in for the Ravenscare meeting, start working out where the money will come from to get you to the meeting whether you present or now, and, ... we'll see you there!
[HTML readers (24.iv.95): there's always 1996 Ravenscar, and submitting something for the next issue of NETWORK see EDITORIAL and REVIEWS WANTED . Now, please let me know more: Chris Evans Email : ME! [if your HTML browser doesn't support "mailto:" then use a mail package and send to: C.Evans@sghms.ac.uk] [Page 8 in printed version] [return to index]