Interview with Monique Thurin - Doctor of Language Sciences, specialist in discourse analysis and qualitative approaches, she has participated in several studies to evaluate the process and results of psychotherapy
Gregoire Vitry
For the record, our database, the basic tool of our program, is filled in and put at the service of therapists, research partners practicing the Palo Alto method.
We also want to initiate collaboration with university researchers who use other brief therapy methods, to create a scientific, rigorous and recognized methodology for measuring the effectiveness of our program.
You are yourself an academic and researcher at Inserm; this is why I took the liberty of contacting you for this interview, which is certainly rich in advice for our approach.
Monique Thurin
Yes, I am on familiar ground because that is what we have done through our research: the evaluation of our psychotherapies.
Gregoire Vitry
We are not university researchers. So I would like to find someone to help us in this area.
Monique Thurin
What exactly do you have?
Gregoire Vitry
We are able to produce a lot of statistics from the data that are encoded by the speakers-researchers who participate
Monique Thurin
For research, the data must be adapted to the question and to the analyzes
Are your data qualitative?
Gregoire Vitry
We do not enter verbatim
The core of our methodology is:
- what is the type of intervention,
- the time it took to solve the problem,
- What is the problem,
- what is the logic,
- is the problem solved
Monique Thurin
What exactly is your assessment and in what form?
Gregoire Vitry
It is the therapist and the patient who decide and note from 0 to 10.
Gregoire Vitry
Giorgio Nardone has already worked on this type of evaluation; he compared the results obtained in therapy with pathologies (see the work Silloner la mer à l'insu du ciel). It's very interesting.
Monique Thurin
The difficulty you will encounter in the field of research is that the evaluation is done by the therapist and the patient, but you have no outside view. We will have to find a solution on this aspect of things.
Gregoire Vitry
We have what we call follow up, to register the change obtained in the patient over time. We do this systematically after a year of follow-up therapy.
Monique Thurin
This is an important data in the methodology. When you start a search, you will have to limit it in time. If you estimate that you have results after two years, your methodology will have to provide for research over two years.
Gregoire Vitry
With us, we have an average of 10 sessions, which is not a lot. What we focus on is the sustainability of the change. Once the person has changed, there is no going back. On issues of addiction, paranaia, there is no relapse.
Our subject of study is efficiency in itself; we are not looking for comparisons because we do not want controversy.
We have 200 encoded patients. So we have the tool but we need the help of a research director who might be interested.
Monique Thurin
I understood well ; you already have a lot of items. You need to set up a methodology, with the Laboratory, so that it is as adequate as possible. Because you will be able to answer lots of questions. For example the points in relation to efficiency, there is a bias that will have to be circumvented.
Gregoire Vitry
In our method, we set a simple, measurable, achievable goal. And we're talking about efficiency in relation to that goal.
For such a patient, we will focus on a problem and we will follow a problem-solving protocol.
Monique Thurin
Yes, it makes sense to start from the problem
Gregoire Vitry
Indeed, but the problem, we detritcote completely; the goal comes later. Once we have determined the problem, and it sometimes takes 9 out of 10 sessions to get there, we have done most of the work. Example: “You are not stressed, you are assaulted by your husband. Do you want a separation or just to live better with him?” And, in the next session, we ask: “Have you found a relational mode that allows you to get better. ?”
Our goal is not to reduce symptoms. We are going to inject disorder into the patient's order systemically. We do not stifle the symptom, we increase it. This is the great paradox of Palo Alto.
Monique Thurin
We must think about making adaptations so that there is validity of the data at the research level.
Gregoire Vitry
We bring the software and the data and we don't ask for anything else.
Monique Thurin
In what form does your data come out for analysis?
Gregoire Vitry
We make queries and we output arrays. We can compile statistics, in the form required by the research unit. Partners can also enter qualitative data that does not enter the statistics. I must stress all the same that all the practitioners of Palo Alto do not work in the same way therefore do not enter the same codifications.
Monique Thurin
We have implemented several methodologies, particularly in 2008.
Gregoire Vitry
The therapists who join us must encode at least 20 patients per year and must participate in web conferences to discuss quantifications and codifications.
Monique Thurin
The analysis relies on the objectivity/subjectivity of the clinician, doesn't it?
Gregoire Vitry
There is the patient all the same!
Monique Thurin
Yes, but these are biases that you will be constantly criticized for; therefore it is absolutely necessary to find a way to control what the therapist says with, for example, a control group. We need to work on this aspect with the research team. Because in research, you need pure and hard reliability.
What could perhaps be interesting for you would be to focus on certain pathologies. Depending on the results you get in therapy.
