Understanding Responsiveness in Psychotherapy with Dr. William (Bill) Stiles

Dr. Bill Stiles returns to the show to continue the discussion on understanding responsiveness in psychotherapy.

Dr. Stiles discusses the Fever Model in therapy, emphasizing the relationship between client disclosures and therapeutic outcomes. He explores how depression can impede the natural process of disclosure, which is often an adaptive response to psychological distress. Then, Dan and Dr. Stiles delve into the complexities of responsiveness in therapy, the challenges faced by novice therapists, and the importance of theory building through case studies. 

Special Guest: Dr. William Stiles

Additional Resources:

Stiles, W. B. (2021). Responsiveness in psychotherapy research: Problems and ways forward. In J. C. Watson & H. Wiseman (Eds), The responsive psychotherapist: Attuning to clients in the moment (pp. 15-35). Washington, DC: APA Books. https://doi.org/10.1037/0000240-002

Stiles, W. B. (2009). Logical operations in theory-building case studies. Pragmatic Case Studies in Psychotherapy, 5(3), 9-22. https://doi.org/10.14713/pcsp.v5i3.973. Available: http://jrul.libraries.rutgers.edu/index.php/pcsp/article/view/973

Stiles, W. B. (2017). Theory-building case studies. In D. Murphy (Ed.), Counselling psychology: A textbook for study and practice (pp. 439-452). Chichester, UK: Wiley.

Stiles, W. B. (2011). Coming to terms. Psychotherapy Research, 21, 367-384. https://doi.org/10.1080/10503307.2011.582186

Stiles, W. B. (1992). Describing talk: A taxonomy of verbal response modes. Newbury Park, CA: Sage.

Stiles, W. B., Shapiro, D. A., & Elliott, R. (1986). "Are all psychotherapies equivalent?" American Psychologist, 41, 165-180.

Stiles, W. B., Barkham, M., Mellor-Clark, J., & Connell, J. (2008). Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary care routine practice: Replication in a larger sample. Psychological Medicine, 38, 677–688. Published online 10 September 2007, https://doi.org/10.1017/S0033291707001511.

Stiles, W. B. (1987). "I have to talk to somebody." A fever model of disclosure. In V. J. Derlega & J. H. Berg (Eds.), Self-disclosure: Theory, research, and therapy (pp. 257-282). New York: Plenum Press.

Stiles, W. B., Honos-Webb, L., & Surko, M. (1998). Responsiveness in psychotherapy. Clinical Psychology: Science and Practice, 5, 439-458.

Stiles, W. B., (in preparation). How talking helps: The assimilation model.

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Chapters

• 0:00 Introduction
• 1:11 The Fever Model of Disclosure
• 6:02 Correlation Between Disclosure and Therapeutic Outcome
• 12:10 Depression and Disclosure Challenges
• 18:57 Responsiveness in Psychotherapy
• 26:02 Theory-Building in Psychotherapy Case Studies
• 38:08 Abduction and Theory Refinement
• 44:00 Pushback and Scientific Debate in Psychotherapy Research

Transcript

0:00

[Music] Broadcasting from the most beautiful city in the world, I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to episode number 38 of Psychotherapy and Applied Psychology, where we dive deep with the world's leading applied psychology researchers, don't cover practical insights, pull back the curtain, and hopefully have some fun along the way. If you find the show useful, it'd be much appreciated if you shared it with someone else who might enjoy it too. Today I can be more excited to welcome back one of the world's authorities on the process of psychotherapy. My guest is a professor emeritus from the Department of Psychology at Miami University, past president of the American Psychological Association Society for Psychotherapy, and past president for the Society of Psychotherapy Research. He's received many prestigious awards, including Distinguished Career Awards from the Society for Psychotherapy Research, and the American Psychological Association's Society for Psychotherapy. He's also a fellow of the Association of Psychological Sciences, and the American Psychological Association, and he's been categorized as one of the 50 highest impact authors in psychology. In this part of our conversation, we discuss several aspects of the process of psychotherapy, including the fever model of disclosure, therapeutic responsiveness, theory building, and much more. This episode starts with my guest telling us about the fever model of disclosure, so without further ado, it is my pleasure to welcome back my very special guest, Dr. Bill Stiles. The fever model, which we have a history of talking about the fever model, apparently. But this was, for me, it was a very early thing that pointed towards responsiveness. The fever model was again a kind of a null resolve, which was that the following on this little study I said that we showed that clients were doing disclosures and edifications, that they were talking just sort of subjective, and they were giving information about themselves, subjective and objective. That's sort of what was the client role. We also did an equally little study. We actually used the training manual for the experiencing scale. I don't know if anybody remembers that anymore, but it was a kind of a measure of good process. And the experiencing scores had a super high, I forget what it was, but a really high correlation with the percentage of disclosure by clients. As clients, if in the rated segment, the proportion was high, then that was good process. So that was high enough, I forget, but 80s or something. For our business, it was a correlation that said, wow, we're talking about the same thing here. I should just take a moment to say the experience scale is sort of like a measure of depth of experiencing of whatever you're talking about and sort of making sense of it. But I always sort of think about it. It's not totally just depth, but I feel like a big part of it. It is depth. It came out of the person centered shop. The idea was that deep experiencing was an avenue to change. And what you were trying to do with therapy was to get people to experience these things. And what was the rated scale was just turned out to be very similar to the proportion of disclosure as defined by verbal response modes. And really the response mode definition was not exactly what you would probably think of as overlaps, but it's not exactly the same. It's really subjective versus objective. So with people who are talking subjective, then things that were going on inside them that you couldn't tell without, you know, you have to ask them to find out if it's true, that kind of thing. It's good process. Okay, so disclosures are highly correlated with good process as person centered therapists were viewed in any way. But disclosures were uncorrelated with outcome. So here, so you would think that good process would lead to good outcome, but it didn't happen just like all the other verbal response modes. I mean, client, client disclosures who are not predictive of good outcome. And the logic was kind of the beginning of a responsiveness notion was well, maybe it's like a fever. And the idea of a fever issue temperature goes up. And that's a good thing because it shows that your body is responding is responding adaptively to the presence of a micro wheel and invader or something like that. And so it's a good way to raise the temperature and whatever the microbe has trouble surviving that. And so it's the bodies of the adaptive response. But you would not expect so it's a good thing. The process is good. But you would not expect the people who have the highest favors to necessarily get better. And the best outcome of their disease, the people who didn't get a fever probably didn't have such a serious disease. And will probably may do better. So the disclosure is kind of like a fever. But the idea being that disclosure is an adaptive response to psychological distress. And so that is if you have a lot of distress, if you have a serious problematic experience, then it's adaptive to tell somebody about it. And getting it out is a good thing. But that doesn't mean that the people who have the most distress are going to do the best in a psychotherapy trial. And that couldn't very well be the opposite. You know, the people who are most distressed typically don't do as well as the other people. So the failure of the correlation is not surprising if you. It's a response in this explanation. That's kind of a long way to go. So if we just look at disclosures as predicting outcome, the problem with that, the reason why it wasn't showing up in the way that you thought it was is because disclosures in this sort of analogy, I guess, are like a fever in that people who are disclosing more are doing so because they're in more pain. So that if we just look at disclosure, that's so highly correlated with pain that basically the people are different people, right? They're different, they're experiencing different things which lead to the high disclosures are also the high pain. So I want to have obviously which we're speaking generalities here. So to say, well, high disclosures are going to do better overall that might be true if we could control for the pain that they started with. Yeah. Because it's so highly correlated with pain, what you really ask what you're pretty close to asking is unintentionally is the high pain or testing the high pain people will get more better. And it's like, well, that's so that's that that's that's obviously not. Yeah, right. If we can completely control if you could if you can make everything the same and give let some people talk and some let not people not talk and prevent prevent some from from disclosing the way they want to. Then then they probably wouldn't get is they probably wouldn't do as well as the people who had a chance to disclose. That's why therapy works probably. People that people who can disclose who have who have the do better so we would like to think that but but if you if you throw in all these other people it's it's a reason you know as I say it's a responsiveness explanation it mean that the that the people's disclosing is responsive to their pain it's what they need to do. Right, it's like this adaptive adaptive coping mechanism this adaptive feature just like a fever is an adaptive feature right that's the idea. But but it doesn't mean that the people who who have the highest fevers are going to be the healthiest any more than the people who do the most disclosing are going to be psychologically the healthiest. It's you know because it's an index of of distress it's an index of mythology in in in population right yeah and so I stumbled it's not a controlled experiment you're absolutely right right well so I stumbled across your work. This work a while ago because I was doing work with a colleague of mine Jeff con and he's been doing it for much longer than I have and so I sort of he was fortunate to sort of take me on and support me and stuff I was interested in but he's done a lot of work on like how folks who with who are more depressed how depression impedes their disclosure and sort of this idea of that folks with depression that this sort of natural if we wanted to use a term emotion regulation strategy of disclosure that one of the things that's sort of getting in their way is that they aren't disclosing you know so those sort of interesting yeah and right and so like it sort of gets to right when we think about these you know one of the things with psychopathology broadly speaking if we think about it like you know folks with consistent psychopathology are there's something going on that is impeding that natural healing process right that that sort of effective thing that's going on that people experience and so the argument that well it's closures an adaptive way of dealing with distress and so with folks who are depressed if they are in fact not doing that then that's going to get in the way of them feeling better and I think that you know I would argue that this tendency is you know it's a tendency it's not just limited to folks who have depression but yeah just thinking about that so anyway so I thought that your work on the fever model was really helpful as I was parsing through this and trying to make sense of like well what's actually happening here no that's really interesting so yeah so that so that by essentially this is it would be analogous to preventing people from having a fever that if somehow deep right depression if depression somehow keeps people from from doing this natural thing that would would would fix it yeah no that's exactly right right and so you know I have two younger kids and so you know as a as a parent particularly when they're little little you know little ones get these fevers that are to us it's like this per you know we got to go to the hospital yeah but like the idea of and that's what I thought that your work was really influential for me that was actually probably when my kids were very little and it was like this makes sense right because I as a parent you're making sense of it right you're having to learn about why does my infant have this experience and what should I do and oh this is this actually is adaptive and I shouldn't give them this medication to reduce their fever right now until it gets to a certain point yeah so the parallels I think work work quite well yeah so I think one of the things in terms of your work on responsiveness and I read the your paper with I think it was your paper with Adam Horvath maybe yeah yeah and it really I mean still sort of sticks with me which is that sort of this paradox if you will that when we're thinking about responsiveness we don't know if what we do is actually responsive until after the fact like we don't know if what we do is responsive until we see how the client like it's impact on the client so and so it and I always I think about that a lot because it makes it as a researcher it makes it very difficult and it's really I mean it speaks to you know when you were looking at just the verbal response modes why it wasn't playing out because it didn't take into consideration what the client needed and it didn't take into consideration and then it didn't you know it wasn't also tapping well did this actually help the client like what was the client's response or reaction to my responsive intervention I just I just think about that a lot in my own work yeah when wanting to do research and wanting it to be meaningful so I guess I was just sort of since I had you here I just I just wanted your general thoughts and where you were with that at the moment well yeah okay I mean this is this is I mean for me responsiveness has been more a problem and I mean it's stuck in trade for I mean to start with being responsive is a stock in trade for with for therapists I mean that's the whole thing we do is we try to do well a little semantics that the I mean responsive responsiveness I think if you if it's I think it helps me at least to to think about it not as necessarily a positive thing responsiveness just means doing some your behavior being influenced by emerging context and so you know if my idea is to to cheat you out of your money I can be watching very carefully be very responsive to what you do and and and get all your money and I've been I've been extremely responsive but it was but it was not benign but so I mean that's a semantic clarification I think for therapists we assume and mostly do have I think pretty benign motives we're trying to help people and so and so but to be strictly really what we're trying to be is what I would call a pro I call appropriately responsive there is we're we're trying to do the right thing and so and so that and so that it helps I think should be when you talk about instead I mean it responsiveness is a good technical term I could umbrella but actually we're saying do the right thing okay well so it's clearer when you say that that that's a puzzle you know do the right thing it's not like it's not like we can it's not like we have a manual that says what the right thing is the right thing depends on all these things you know the list you know we we've made lists and you can you can you can easily list a hundred things and go to somebody else and they can list another hundred things that go into determining what the right thing is in a particular circumstance it's you know it depends on who you are who the client is what the circumstances what the history is and so on and so on so so yeah you don't know what the right thing was until you see if it turns out right you know I think that you know I think we said before that that that it's we're trained and adapted to do the right thing you know to to to to get some we have some idea what the right thing is and I think we you know on on the whole I think people don't do a terrible job of that but but yeah okay so where was I going with this I mean I don't know if I've answered your question yet repeat it right come back at me obviously if I can I can I think that it's this idea of I mean it's really a challenge for I guess for therapists and for researchers you know as the therapist what you're what you're and I can particularly speak to novice therapists that's where I spend most my time with right there they're kind of right and you they don't know what the right thing is but they're well I mean they're novice therapists but they're not not as people for the most part and mostly they get selected for for for for being able to be you know to be socially appropriate you know most of the most of the clinical students have always been good listeners and they they got pushed into this because their family and friends found the palpful to talk to you know so they're they they come in as a relatively talented bunch and then and then they get better hopefully right and they're constantly but they I mean particularly you know novice therapists they constantly want to know like what do I do what do I do right and so they are looking for an idea this to right they do want a me too that's why the response was so helpful right right right but they do want a like a cook walk right to an extent but what you what the responsiveness work is saying like well there there really yeah there isn't there isn't no there isn't not really not you know it's not it's not following instructions it's not like you know you know yeah there's not a cookbook for I agree yeah yeah it is the response of this problem and then I mean I mean I've been more I mean I think it's it is really interesting question how therapists do decide what to do how do they decide what what their responses are I mean the experts therapists and you know and then you know how do they maybe you could look at whether they the you know one of the interesting things and this kind of leads to is I didn't get my name for this thing I called the person phenomenon which is that people can tell whether it was right or wrong that it's it's it's it's quite astonishing how how you know how how Raiders can do can rate with good reliability whether people did the right thing you know given all the circumstances which is and I don't know you ever did you ever read Zen in the art of motorcycle maintenance no I never did okay there's a it's a it was popular yeah I've heard of it a long time ago I mean I I recommended but but it was written by Robert Percy and that's where the so that's what my the name for Percy phenomenon comes I mean he goes it's a story about taking his son on the boat taking his son on a motorcycle trip across the country but it's mostly a meditation on a lot of things and one of the main things is what he calls quality and how people can can identify quality they can tell you when and when something is a good one or not a good one but they can't in general tell you what quality is right I mean I think that's I think that's what we're dealing with here is that people that that doing you know that we're doing the you can do the right thing and people can to some extent I mean not perfectly but they can tell whether they're doing the right thing or not and other people looking at it can tell whether it was the right thing or not but it's just what difficult to say what exactly is that you know I mean you can say post-talk what was good about it that part that part we can do but but they're saying in dance what the right thing is what what what is really good about anything but in but in specifically about therapy therapy responses you know it's it's really hard yeah that's that's a really interesting point and I really I take your point to about being able to see it I know that in like process research that I've done when you're reading transcripts and going you know you can sort of see like oh yeah all right these two are moving somewhere like they're they're on the say you know they got there this is doing well and then you read other transcripts and it's like what what what is this therapist why what do you you're missing they just said and you're not paying attention to and you know you know and especially you know there were many times where I'm reading transcripts you know alone and I'm sitting in the office yelling at the therapist you know as I'm reading but it gets your point though of like it does it is somewhat self evident although it might be difficult to articulate well I don't know that I'm not sure everybody gets it right but but it is possible you can do a lot better than chance at reading these things and and people do a lot better than chance at doing the right thing I think so but yeah far before so I think before before we close up I wanted to give you I wanted to chat just briefly about theory building case studies and you've done a lot a lot of work on this both applying these but also methodologically talking about or just sort of developing yeah method methods for doing these sorts of things and I think probably a lot of people listening will be well I can always speak for myself maybe that I'm relatively you know naive to these and and how they work so I'm wondering if you could just sort of give a sort of a 30,000 foot view of you know what theory building case does yeah well I think of it as really just an application of normal science you know that it's it's it's that you know if you read the textbooks the method textbooks they'll say that you know what you do is you have a theory and you make observations and see if they observations fit the theory that's that science and if you know if it if it fits then your confidence is increased if it doesn't fit then your confidence is decreased but they don't always say this but in fact it's also an opportunity to adjust the theory so that it does fit and I don't I mean I don't think anything I'm any part of this is novel but I but I think it's important it's important for psychologists is because we've we spend so much time thinking of of statistical hypothesis testing is being like the way like that's what we do I mean because it's a it's a it's a logic that can be used with with qualitative research and I think for doing psychotherapy I've come to think this is like and I didn't I did statistical hypothesis testing for years and so I this kind of a conversion that a little quite a while ago now that that for for most of the things that we study and care about we don't have statistically testable quantities of the observations on the same variable to do the test we want and so you know we can say all right well we'll look under the lamp post and and just and only study things that we can get lots of what lots of observations in order to do statistical tests on but I don't think the logic Greek I don't think that the scientific logic requires that you can and you can you can look in an individual case I mean our psych our theories you know psychoanalytic theory cognitive theory all the cognitive the theories we have are used clinically to the extent that they're used clinically they they do did they describe particular cases they're they're just you apply them in particular in particular cases they're not M okay this is anyway so all case study is doing is is is looking at cases and seeing if it fits the theory and if it does your confidence is increased if it doesn't then you you you change the theory so that it does but keeping in mind that all the observations have to still fit so you can't just change the theory anyway you want there's a there's a little piece of logic in this that actually traces I do you know who Donald Campbell is anyway Donald Campbell with he well I don't know he was he was a famous psychologist back when I was in in graduate school as many many years ago and if you've ever heard the terms external and internal validity is that sound vaguely familiar yeah of course I mean this is this would be is this cooking Campbell Campbell of cooking yes yes yeah yeah that's a guy anyway he this is his logic he he spent a lot of his he was the statistician one of the things and he and he spent a lot of pages saying mean things about end of one studies you can't you can't you can't conclude anything from them and then later in his career he wrote a paper called degrees of freedom in the case study where he he quoted all these mean things that he said and explicitly retracted them and and and said well maybe there's maybe there is something to this after all and I'm adding a little bit to his logic but basically what he's saying is if you have a theory that deals with many different aspects of a person let's say or anything really but as you do if you have a theory like the assimilation model is describing a lot of things there's so if you did a case study there's a lot of a lot of specifics in that case study you can point to the voices you can point to the experience as you point to the meaning bridge and so on and so on goes on one time and and they're all doing these different things and an a case study you can make observations on all of those things on lots of things okay so in a case study then you can make a large number of theory relevant observations and what he's arguing is that those many observations on different things is analogous to degrees of freedom in a statistical in a statistical hypothesis testing study so that rather than making across many cases making one observation on each case on a particular piece of the theory you're making instead you make many observations on different aspects of the of the theory in the same case okay now neither one of those will prove the theory I mean I mean one one statistical hypothesis one significance is nowhere close to a proof of a theory but it gives you more confidence in the theory if it works and likewise you know one case that fits the theory very nicely gives you a little bit more confidence in the theory and it's but it's based it's based on I mean if you counted those observations nobody including me is actually tried counting these things yet but the but the principle is that if a rich description if a rich description of the case fits the rich description of the theoretical rich the theoretical account then that gives you justification for a little bit more confidence in the theory and a lot of case studies just like a lot of hypothesis testing studies gives you more confidence and it's always a it's always a matter of increment so what what that's just saying is that qualitative so there's a qualitative observations and what what's saying is the qualitative case studies gives is is a intellectually responsible respectable way of doing science that there's no reason to say that that's that that's you know I mean there's I mean there's lots of ways things that are wrong with either kind of study it's not like it's it's not perfect but it's but at least it's on this it's on a very similar footing and it's a respectable way to do real science that's my point and and that's what I think that's sort of Campbell's point he didn't give quite the emphasis to theory that I do because but I think that what this really rests on is having a theory that you stick to and you have to you I mean you have to use the same theory across a lot of cases just like you have to use the same theory across a lot of statistical hypothesis testing studies a sign note here in this polemic is is that a lot of of actual psychological research is what Thomas Kuhn would call fat gathering rather than rather than normal science normal science is puzzle and it's not just a lot of the following around a theory but a lot of a lot of psychological research not just in psychotherapy is not really theoretical theoretically guided it's just it's just gathering facts in the hope that maybe somebody will someday put them all together or something like that or that or that will just or that will just use them you know use them by analogy you say well you know my situation is sort of like this thing this this study and so I conclude conclude something but I mean that's that's even weaker as a scientific logic the scientific logic is is has to do with with theory that's the whole point that's the product of science is an account but theory in the sense of an account of the real world that allows you to to you know that that makes a connection so that it tells the truth about the real world so that what what the what the what the words of the theory say it corresponds in your experience to your experience of the observation and okay so does that mean so that's the that's kind of the theory building logic and I think it works I don't think I I mean Freud's a great example of somebody who did this you know he built he used qualitative case studies to to build a theory which you know has its has its its strengths and weaknesses of course it's you know as far from finished it's got its problems but but it also has got quite a bit of staying power so so I want to hit on the so like so like you know as with any theory there's right so there's a lot of tentacles to any or a lot of hypotheses to any theory and so is the in terms of what you're saying like so I can test or evaluate any number of those in a single case study which gets to your multiple degrees of freedom within a single case within a person or within a diet or whatever the so but you know most likely if one more to do this then the I would think the most likely scenario isn't oh this kit this whole theory stinks or this whole theory is great it's probably that a theory has its strengths and weaknesses and some things that are going to hold up over time and some things that aren't as you talked about you talked about sort of modifying so is in terms of thinking about this as building theory or refining theory do you would it be something like so if you know if we look at a bunch of aspects of the simulation model I'm just sort of pick this out that it would be that when after doing a number of these case studies and we start to see oh you know what this one hypothesis that we had within this theory that had a dozen hypotheses or whatever this one seems to consistently not hold up so we're looking for that consistency across a number of case studies to really before we sort of modify our theory oh I think I was right guide don't go ahead please no I think it's no absolutely there's a there's a term that David Rene sort of rescued from anyway slipping my philosophers whose name slips my eye at the moment then anyway I call the abduction and that it's it's that you changing what changing the theory you're allowed to change you know that abduction is a he wanted to make a logical operation like induction and deduction and induction sort of gets sometimes what we what Rene and I can't remember his name was 19th century philosopher that anyway that is it gets into induction but he says it's a separate thing which is that when that it's it's the creative process in science it's it's just fight if if if you see something that doesn't either is not covered by your theory or is mispredicted or whatever has is an error then you know you know my wife's here and she she's she reminded me it's the the guy's name is purse Charles purse but that is philosopher I'm impressed she knew that the she's heard me say a lots of times but anyway that's that you see something that's an anomaly from the point of view of the of the theory and the logic is if I were meant to make this change in the theory then the theory would account for this then adding that that little twist to the theory is is called an abduction so it's a creative thing it's a way it's sort of saying I can change the theory to fit I always want to add more I say that I think I said this once before that that you can't just add anything it's I mean it's sort of like making the theory fit the data and it is making the theory fit the data which of course is in long term is just as the whole point but you have to but you're strongly constrained by all the previous observations that's why you have to have the same theory all the time that is you can make a change but if that change means some of the previous observations don't fit anymore then you're not allowed to do it you have to make a theory that changes so the more observations you make the more constrained you are but also if you can come up with a change that fits then the theory has gotten more powerful and so the the ideas that you're forever making these little little tweaks in the theory sometimes major tweaks but even those are constrained and and and the theory just keeps getting better and better so you can start the nice thing about this is you can start anywhere you can start with a crappy theory and if you if you're diligent about making the observations and making sure that the than every time you see an observation that should fit but doesn't change the theory so that it does then you the theory keeps getting better and better and better so it's and the fact and I would make it even the condition even stronger the I mean a good theory should explain everything so if it if it happens if it doesn't happen in just one case if there's just one case where there's something that doesn't fit or isn't explained I mean you first look at the method maybe your observation was wrong or something like that but that's justification for changing it so so case studies you've got all these ripshod observations you can make a lot of odd you know any case study will have lots of things in it that are not really explained and so it's just a matter of your attention and creativity that will allow you to that to improve the theory to make changes in the theory that if they if they and yes the more cases you have then that it constrain the theory more of course and the process of doing that is far from you know it's it's it's much looser than I'm describing it now what people actually do but I but I think that the but the process is works I think I mean yeah and it's it's very freeing because it means that we can use what are mapped to clinical observations as for science right I think about the sort of work particularly in our field where many of our graduate students are going on to be practitioners you know not researchers and so they're dealing with cases all of the time and that and you know to use that to inform science but also to use that inform their practice and sort of the value of you know learning sort of these sophisticated methods of doing case studies I think is something that we've been talking at least locally in our program about how can we embed this more into the program because it you know I very much did not get this training but neither right but the you know and I think that your work and others that really is moving us forward and our thinking is really valuable and something I think that will be being increased increasingly picked up on well I think so I mean I want to just just with that kind of future in mind I want to just want to bang on the idea of of theory exactly and and theory building is a maybe I mean it's theory guiding theory refining it doesn't mean building a new theory I mean so one kind of I mean grounded theory is it often gets is a different thing altogether I think I mean it's I mean in reaching well it's another conversation but there's a thing I would call it reaching call a qualitative research which doesn't have theory guiding it's sort of the ideas that you just sort of open things up and see more things and you know I mean theory is part of it you can make up a theory but every every study has a different theory I mean that's not I mean that's it's a valuable human activity but it's not science I think I think that's an important feature yeah no yeah I that I very much agree with that so one of the things I was like to at the end of these conversations is I'm always curious if there's any pushback that you've received for any of your work overall when you said yeah yeah but that was on your on your list of the other question that that was on your I thought about it a little I had fun for it was actually a part of research that I we did some dodo research with a great big naturalistic data set in England using the core of mostly with Michael Barkham and and using the core which is the core is a measure it's a it's a symptom inventory checklist distress measure which widely used and you know we had like tens of thousands of of people in in in a couple of studies and and they were and who according to their therapist were treated with either cognitive behavioral therapy or person centered therapy or psychodynamic therapy and and the outcomes were exactly as the dodo said you know we had you know we had you know thousands and thousands of degrees of freedom and and non significant differences between these treatments well is naturalistic and there's a zillion things that are can be wrong with it and David Clark who is and a couple of his colleagues who were who's an advocate of of CBT and sort of the architect of of the big program there improving access to psychological therapies anyway he wrote a he wrote a quite critical complaint about this he I don't I don't know I don't want him to he favors cognitive therapy put it that way and and was you know said mean things about us and and we wrote and we wrote a rejinder which I thought took him to task about some things so anyway so that was push back and it was it was actually great fun on my perspective and you know I think there's nothing more fun than getting attacked in print but but but you know I it is what what why why do you think why do you think that there's nothing more fun than being attacked in print it's it's it's a lot similar to it I think it's similar to no such thing as bad publicity you know it's it's you know it's it's a chance to well I mean it's like a bit like what we're going now except that you know it's it's it's you know there's time to be thoughtful about what the issues really are and you know to to take somebody to task and pull apart their arguments and I mean he pulled apart some of ours and he was writing some respects and and he was wrong in other respects I think but anyway I I found that fun but but the the I mean the the the other kind of pushback I had the the occurs to me is about the responsiveness which was in a way it was not exactly push back it was like you know I've been writing about this stuff the correlation problem and responsiveness since at least the night late 1980s I've been putting it in those terms since at least the night late 1980s and the response I got I presented conferences I wrote papers to say people would say Bill that's great that's really good idea and then they would go back and and do process outcome correlations the same as they were doing before and so the pushback was you know they would say nice things but actually it didn't seem to have much impact now it had a sort of a happy ending because you know starting I don't know maybe 10 or 15 years ago the response of this kind of got some play and people have been have actually been working on it more seriously so I sort of feel like you know that was that was I got lucky there but but well I wasn't lucky exactly because I banged on about it for all those 30 years 40 years it was you know I've been I don't know how many times I've written about about this stuff and that's it's an example of what we mentioned earlier I think of of you know people don't read it you know people are influenced by it and it just takes a long time for these things to settle it. I mean that gets back to sort of the at least how I think about like what at least the what of Kuhn that I've read sort of like that you trying to change the conversation and that like changing the conversation is not an easy thing right and so you sort of do have to bang on about it but it is a good good lesson or a good reminder I guess that like just because you know one thing feels like a you know drop of water in the ocean that if you keep with it that there's you know there's value in that. So the other thing I always ask and you sort of is about you know one or two resources or readings or whatever that folks who want to learn more about your work and you sent me a lot of them so I list all of those in the show notes which is great I think it's wonderful is there are there one or two in particular you want to point to people to or do you mean just sort of well no I mean what I when I sent you was because we've had a lot of different we've covered a bunch of different topics and and you know I've been in this business a long time so I've had time to do different things and so it depends on what things people are interested in no no one is just a matter of which which topic they're interested in yes yeah okay and there's lots more I mean I'm I'm delighted if somebody would like if somebody wants to write and get more reprinse there's more about all this stuff. That's a wrap on our conversation about the process of psychotherapy as I noted at the top of the show be much appreciated if you spread the word to anyone else who you think might enjoy it until next time.(upbeat music)[Music]