PRE-THERAPY: CONTACT AND CONNECTION

1. PRE-THERAPY: CONTACT AND CONNECTION

2. Keynote Speakers • Lorna Carrick: Teaching contact work to people who work with clients on the autistic spectrum • Dione van Werde: Personal reflections on Pre-therapy contact work in a hospital setting • Rab Erskine: Using Pre-therapy in wilderness contexts

3. Workshop Presenters • 1. Wendy Traynor: Pre-Therapy with people who hear voices or dissociate = FULL • 2/5. Mathias Dekeyser: Monitoring communicative contact:  (a) history and (b) practice • 3. Lorna Carrick & Anna Robinson: Training in Contact work • 4. Pam Courcha: Supporting home carers in their work with people with dementia • 6. Rab Erskine: Introduction to the physiological and therapeutic benefits of nature = FULL

4. Reminders • If you haven’t signed up for a workshop, just go one that isn’t full. • There is an evaluation form in your packet. Be sure to fill it out before you leave & leave on tables for us to collect.

5. Welcoming Contact Work within its Multiple Contexts Robert Elliott University of Strathclyde

6. The Contexts of Pre-Therapy Contact Work • Historical Roots • The Relational Continuum • Scientific: The State of the Evidence • Political Marginalisation • As a Key Therapeutic Task

7. 1. Historical Context • 19578-63: Wisconsin Project: Rogers, Gendlin et al go off to Mendota State Hospital in Wisconsin to test the Process Equation with psychiatric patients labelled as “schizophrenic” • Today regarded as a noble failure • But developments in practice in the study sow the seeds for Focusing & Pre-therapy • Gary Prouty (1936-2009), developer of Pre-therapy/Contact Work: • Grows up with severely mentally disabled brother with psychotic processes • Strongly influenced by Carl Rogers, Gene Gendlin & Fritz Perls • Becomes fascinated in Rogers first condition, that there be psychological contact between client and therapist • 1966: Begins working to develop Pre-Therapy for people with dementia & psychotic processes • Joined by Hinterkopf and Brunswick

8. 1. Historical Context, cont • Prouty’s work is ignored in the US, as North American psychiatry becomes increasingly medicalized • However, Europeans pick up the work, extend it to geriatrics • Netherlands: Coffeng, Peters • Belgium: van Werde • Switzerland: Pörtner • Italy: Dinacci • UK: Sanders • Denmark: Somerbeck

9. 2. Locating Pre-therapy on the Relationship Continuum

10. 3. The Scientific Context: The State of the Evidence -1 • Pre-therapy research reviewed by: • Dekeyser, M., Prouty, G., & Elliott, R. (2007). Pre-Therapy Process and Outcome: A review of research instruments and findings. Person-Centred & Experiential Psychotherapies, 7, 37-55. • In his workshop Dekeyser will describe previous and emerging measures of client psychological contact, and therapist pre-therapy responses • Pooled outcome from 18 clients seen for 6 – 7 months of Pre-therapy: Pre-post Effect size = .64 • Sample too small to influence treatment guidelines

11. 3. The Scientific Context: The State of the Evidence - 2 • Elliott et al. (2013): Promising evidence for effectiveness of person-centred-experiential therapies with clients with psychotic processes • Meta-analysis of 6 outcome studies • Mean Pre-post Effect = 1.08; Comparative Effect = +.39 • Contradicts NICE guidelines banning use of counselling with schizophrenia • Bergmann, Elliott & Peyton updated meta-analysis in progress • 16 studies located & analysed so far • Pilot results: Pre-post ES = .89; comparative ES = +.05 • Based on available research evidence: Pre-therapy and PCE therapies appear to be promising approach • But not taken seriously due to lack of research

12. 4. Political Marginalisation • Lack of strong evidence combined with prejudices about Pre-therapy Contact Work • = > exclusion from existing practice guidelines: • UK: Humanistic Therapy competencies (Roth, Hill & Pilling, 2009); Competences for Psychosis & Bipolar Disorder (Roth & Pilling, 2012) • England/Wales: NICE Guidelines for Schizophrenia (2010) ban on use of counselling for clients • Conversations with Pilling (2009) revealed that he believed that Pre-therapy contact work is mimicry that would be experienced by clients or children as noxious or harmful

13. 5. Pre-therapy Contact Work As a Key Therapeutic Task • Therapeutic tasks: important pieces of therapeutic work that are signalled by client markers and follow a common sequence to resolution. Examples: • Internal conflicts (configuration work or two chair work) • Unclear felt sense (Focusing) • Rather than an entire therapy in itself, Pre-therapy contact can be thought of as a discrete task • Can be applied within a range of Person-Centred-Experiential psychotherapies, ranging from nondirective to emotion-focused • As long as therapeutic conditions are strongly present, even it not currently perceived

14. 5. Pre-Therapy Contact Work Task: Initial Rational Model

15. Further Contexts • Education of support workers, carers & professionals • Hospitals • Wilderness • Home health care • Families • Measurement • ???