Transcript Existential Psychotherapy in the PTS

Existential
Psychotherapy
in the PTS
A qualitative and quantitative
exploration of
goals and goal attainment
Introduction
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Existential psychotherapy
The NHS climate
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Different types of evidence
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Evidence-based psychotherapies
Evidence-based practice and practice-based
evidence
Qualitative and quantitative research
Goals in psychotherapy
Research questions
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What are the goals of clients receiving Existential
Psychotherapy in the Psychological Therapies
Service (now the Complex Care Team)?
Is clients’ level of psychological distress any different
after therapy?
To what extent do clients feel that each of their goals
has been met after being offered approximately 16
sessions of existential psychotherapy?
Is the level of goal attainment linked with levels of
psychological distress, or with number of sessions
attended?
Method
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Participants
 n = 30, 21 women, 8 men, 1 unrecorded gender.
 Aged 19-60 years (µ = 43)
 30% white European or white other, 70% no data
Measures
 CORE goal attainment form:
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CORE-OM:
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At start of therapy: clients write down up to 4 goals/difficulties they want
help with.
At end of therapy: rate extent to which therapy helped with each
difficulty/goal
34 items, 4 domains, overall score of psychological distress.
Other measures not studied here – CORE-5
Results
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Descriptive statistics:
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Average 4.5m in therapy, attended 12 sessions
(ranging from 1 to 24 sessions).
20 participants attended a full course of therapy,
for 8 therapy ended early and no data for 2.
CORE-OM
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75% of clients completed at start, 62.5% at end of therapy.
Clients had significantly lower scores at the end of therapy
than at the start, showing a reduction in their distress.
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Before (M = 22, SE = 1.4), After (M = 16.50, SE = 1.5), t(19) = 3.45, p = .003;
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CI (95%) = 2.16 – 8.84.
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Medium to large effect, d = .77 or r = .63.
Reliable change (Jacobson & Truax, 1991) for 20 clients:
 reliable change, less distress: 11 clients (55%).
 reliable change, more distress: 1 client (5%).
 no reliable change: 8 clients (40%).
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No link between post-therapy CORE-OM scores and
Level of goal attainment
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But there is a link between post-therapy CORE-OM
scores and goal attainment for Goal 1
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(for both mean and best level of goal attainment per client)
(Spearman’s Rho = -.586, p = .028)
Goal 1 is probably a client’s most important goal
No link between post-therapy CORE-OM scores and
number of sessions attended
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(r = .27, p = .26).
Goals: Thematic analysis
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25 participants wrote down a total of 77 goals
(5 participants had no goal forms).
60% of participants wrote down 3 or more
goals.
Length: 1 to 74 words (µ = 11 words).
6 themes, some goals in more than one
theme.
Themes and sub-themes
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1. Self
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Acceptance
Respect
2. Relationships
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Family
Attitude
Roles
Independence
Relating
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3. Acceptance
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4. Making changes
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Building a future
Embrace life
Behaviour
5. Feelings
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Past
Present
Future
More positive feelings
Fewer negative feelings
6. Miscellaneous
Goals: quantitative analysis
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Of all 30 clients:
83% wrote at least one difficulty at the start, 60% (20
clients) rated a total of 57 goals at the end of therapy
(20 goals unrated), on this scale:
How much did therapy help you with this difficulty?
0
Not at all
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1
A little bit
2
Moderately
3
Quite a bit
4
Extremely
Of these 20 clients:
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most (78%) wrote down three or more goals for therapy.
Goal attainment: All goals
Goal attainment - all goals
20
17
15
10
5
0
16
14
8
od bit
er
Q ate
l
ui
te y
Ex a b
tre it
m
el
no y
go
al
no
tr
at
e
no d
fo
rm
tle
M
lit
at
a
ll
2
A
no
t
Number of
goals
27
30
25
20
Level of goal attainment
16
number of goals
Goal attainment per client:
Goal 1
8
7
7
6
6
5
5
5
4
Number of
4
clients
3
2
2
1
1
0
0
0
1
2
3
4
Goal rating
no goal
not
rated
no
form
Highest level of goal
attainment per client
8
9
8
7
6
Number of 5
4
clients
3
2
1
0
7
6
4
3
1
1
m
bi
t
od
er
at
el
y
qu
i te
a
bi
ex
t
tre
m
el
y
no
go
go
al
no al
tr
at
ed
m
is
si
ng
l it
tl e
a
no
ta
ta
ll
0
Level of goal attainment
Number of goals
Mean level of goal attainment
per client
9
8
8
7
7
6
Number of 5
clients 4
4
3
4
4
2
2
1
1
0
sin
is
m
no
tr
Level of goal attainment
g
at
ed
l
go
a
go
al
m
tre
ex
no
el
y
t
bi
a
qu
ite
at
el
y
od
er
m
tle
lit
a
no
ta
ta
ll
bi
t
0
Number of goals
Discussion
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Strengths:
 Combined quantitative and qualitative data
 High ecological validity
 Important time to gather this data
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Limitations:
 No control group
 Incomplete data
 Small sample size
 Some goals not very detailed
 Difficulty separating themes - all interlinked
 My inexperience with Existential Psychotherapy
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Recommendations:
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Good outcomes, pat on the back!
Continue to help clients achieve their goals,
through Existential Psychotherapy, particularly
their main goal (Goal 1).
Therapists to value data collection - integrate
more in therapy, not just tick-box exercise.
Thorough – goals at start, re-rate at end.