Related articles

• Laszlo Czaban (Therapy Today Letters, April 2010) suggests a description for evaluation that has all the characteristics of a randomised clinical trial (RCT). But, as a field, we are all aware of the variety of criticisms of the RCT as a methodology of evaluation. In fact, the National Institute for Health and Clinical Excellence (NICE) hierarchy of evidence is seen as a barrier to many therapies. In the interview reported in Therapy Today (November 2008), Steve Pilling outlined the necessary steps to research, which, of course, include what Czaban describes. However, Pilling also described the value of step 1 research, where simple pre-post studies are done, and the value of step 4 real-world effectiveness research, known in the research world as ‘Phase IV prospective cohort studies’. This step 4 is predicated on the assumption that the treatments being carried out have already been through the evaluation process of steps 2 and 3. The research being conducted within the Improving Access to Psychological Therapies (IAPT) initiative, supposedly, fulfils these criteria. What a wonder then to find an early paper on IAPT demonstration sites results describe the services in the following manner:
  
  ‘…neither (Doncaster nor Newham) could be described as comprehensive services that implemented the NICE guidelines for the psychological treatment of depression and all the anxiety disorders…’ (Clark, 2009 [p11])¹
  
  I would greatly welcome the opportunity for Human Givens (HG) to participate in an RCT along the lines described by Czaban because I believe that, as Salkovskis (2002)² describes, all evidence is valuable in the development of empirically supported clinical interventions. However, there are many barriers to the organisation of such trials, including cost, logistics and ethical considerations. One such RCT study of HG has been conducted by the University of Stafford, commencing in 2007. The treatment arm is long since completed. Unfortunately, the researchers have had difficulty obtaining enough sample size for the non-treatment control group.
  
  Because of this, when I set up the Human Givens Institute Practice Research Network (HGIPRN; visit www.hgiprn.org) as an independent initiative, completely separate from the Human Givens Institute (HGI) or MindFields College, I established a protocol of gathering data by using a rigorous sessional methodology that matches the methodology employed within IAPT.
  
  As a network, we have been doing this successfully now since April 2007, commencing with a 12-month pilot study in Luton and then encompassing over 70 therapists in a wide range of treatment centres across the UK. This is helping us build up a picture of HG across varieties of client groups and therapists and it also allows us to some degree to benchmark our data against IAPT data (although we mainly use the more generic CORE measures rather than the disorder specific measures used by IAPT) and, for planned endings, against the CORE National Research Database (NRD; Mullen et al, 2006).³
  
  So far, with over 3,000 closed cases, the results look promising, moving to recovery rates is broadly comparable with IAPT data and planned endings results sit within the top quartile of CORE NRD data. We are having the first three years’ data independently evaluated. We have already subjected the pilot data to independent evaluation and an article has been submitted to a peer review journal. Three poster presentations were published at the recent British Psychological Society conference at Stratford-upon-Avon. We feel this is a pragmatic way of contributing to the establishment of an evidence base and that we have adopted a sensible methodology that mirrors IAPT methodology. We also feel that if many other therapeutic approaches adopted a similar methodology and contributed to the building of a large rigorous practice-based evidence database, then we could all learn from each other and, as a field, take control back into our own hands so we cease to continue to be subjected to (what some may describe as) the tyranny of NICE guidelines.
  
  We are fully transparent of our results and we openly reveal that we do not help everybody, that folk drop out of treatment and that those who terminate early do not make anything like the same progress in treatment as those who remain to an agreed ending. In fact, as a field, we believe we have the most to learn from those cases that fail to make progress and we believe, as the research of Lambert et al (2003) demonstrates, that obtaining sessional feedback is of great value in reducing premature drop out.⁴
  
  As an HG therapist I concur 100 per cent with the opinion of Ian Plágaro-Neill (Therapy Today Letters, April 2010) that attempting to treat a trauma without accounting for previous trauma and dissociation, is potentially deleterious to the client’s mental health. HG does teach comprehensively about assessment of previous trauma and, in fact, has a protocol designed to greatly assist in the management of cases where dissociation is problematic.
  
  It was encouraging to read how Ian found the treatment effective for clients who had suffered single event traumas and the success with the clients who had experienced traumas was fascinating as it is hard to imagine a more dissociative state than being under anaesthetic, albeit chemically induced. It is well known that all trauma treatments, including EMDR, are more successful in the management of single incident traumas (van der Kolk & Courtois, 2005).⁵ The rewind techinique is one technique for treating trauma amongst many.
  
  I, and I believe many others trained in the HG approach, also respectfully concur with Anita Tedder’s call for a ditching of any evangelical style and grandiose promotional material produced about Human Givens.

• Bill Andrews
  Senior associate with the International Center for Clinical Excellence (www.centerforclinicalexcellence.com).
  
  The opinions expressed above are Bill Andrews’ own and should not be taken to represent the views of MindFields College of the Human Givens Institute.

• References:
  

  1. Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B. Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behaviour Research and Therapy. 2009; doi:10.1016/j.brat.2009.07.010.
  2. Salkovskis PM. Empirically grounded clinical interventions: cognitive-behavioural therapy progresses through a multi-dimensional approach to clinical science. Behavioural and Cognitive Psychotherapy. 2002; 30: 3-9.
  3. Mullen T, Barkham M, Mothersole G, Bewick BM, Kinder A. Recovery and improvement benchmarks in routine primary care mental health settings. Counselling and Psychotherapy Research. 2006; 6(1): 68-80.
  4. Lambert MJ, Whipple JL, Hawkins EJ, Vermeersch DA, Nielson SL, Smart DW. Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice. 2003; 10(3): 288-301.
  5. Van der Kolk BA, Courtois CA. Editorial comments: Complex developmental trauma. Journal of Traumatic Stress. 2005; 18(5): 385-388.