PRE-THERAPY:
CONTACT AND
CONNECTION
Keynote Speakers
 Lorna Carrick: Teaching contact work to people
who work with clients on the autistic spectrum
 Dione van Werde: Personal reflections on Pretherapy contact work in a hospital setting
 Rab Erskine: Using Pre-therapy in wilderness
contexts
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
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.
Welcoming Contact
Work within its
Multiple Contexts
Robert Elliott
University of Strathclyde
The Contexts of PreTherapy Contact Work
 Historical Roots
 The Relational Continuum
 Scientific: The State of the Evidence
 Political Marginalisation
 As a Key Therapeutic Task
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:
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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
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
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Netherlands: Coffeng, Peters
Belgium: van Werde
Switzerland: Pörtner
Italy: Dinacci
UK: Sanders
Denmark: Somerbeck
2. Locating Pre-therapy on
the Relationship Continuum
1. Severe loss of psychological contact: psychotic states,
dementia, severe dissociation, moderate to severe autistic
states
2. Minimal contact: Aspergers process; moderate dissociation;
overwhelmed anxiety states; self-numbing
3. Grey zone functioning: fluctuating, inconsistent contact; mild/
quasi-dissociation
4. Every day relatively superficial connection (friendly or conflicted)
5. Facilitative communication (empathy, unconditional positive
regard, genuineness)
6. Intense relational contact: Encounter; I-Thou; Relational
Depth; Moments of Meeting
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
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
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
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 emotionfocused
 As long as therapeutic conditions are strongly present, even it
not currently perceived
5. Pre-Therapy Contact Work
Task: Initial Rational Model
Stage
Client Process
Therapist Facilitating Responses
1.
Marker: Pre-Expressive State. Severe loss of
psychological contact, eg, psychotic states,
dementia, severe dissociation, moderate to
severe autistic states.
Attend to pre-expressive state
2.
Minimal psychological contact: hints of contact Offer Contact Reflections
present but mostly out of contact.
3.
Grey-zone functioning: Moderate loss of
contact, eg, Aspergers process, mild
dissociation, overwhelmed anxiety states, selfnumbing.
Expressive functioning: Everyday relatively
superficial connection, friendly or conflicted
(=minimal resolution).
Interpersonal attunement to self, therapist,
others.
4.
5.
6.
Intense therapeutic relational contact (=full
resolution).
Monitor momentary level of contact
function; offer mix of contact and content
reflections
Use empathic reflections to help client
their experience; explore possible
conflicts or misunderstandings
Use evocative or exploratory reflections
or meta-communication to help client
deepen or heighten experience
Close nonintrusive empathic engagement;
congruence/appropriate self-disclosure
Further Contexts
 Education of support workers, carers & professionals
 Hospitals
 Wilderness
 Home health care
 Families
 Measurement
 ???