Pluralistic therapy for depression: Development of a multi-site research programme

DCoP Conference 2013, Cardiff Research team University of Strathclyde/Glasgow Metanoia Institute Tempier : Mick Cooper (PI), Simon Cassar, Pavlina Antoniou, Ayse Suzan Aylindar, Jackie DiCroce, Missy Iqbal, Maria Michalista, Fani Papayianni, Shilpa Sreenath : Biljana van Rijn (PI), Ciara Wild (Admin), Sunny Barnes, John McAteer, Stratis Pasdekis, Lia Foa, Adrian University of West of England University of Abertay : Tony Ward (PI), Carole Francis-Smith, Charlotte Mcevoy, Eleanor Brown, Naomi Moller : John McLeod

Aims

• • Describe the development of a multi site study for evaluating the outcomes of a counselling psychology intervention: pluralistic therapy for depression Provide preliminary data on participants and outcomes

Pluralistic therapy

• • • • Strives to transcend ‘schoolism’ in psychological therapies Collaborative-integrative practice: draws on range of approaches and methods to individual client

tailor

therapy to the Emphasis on meta-therapeutic communication : client-therapist dialogue and negotiation to identify clients’ goals, and methods/tasks to achieve them Aligned to counselling psychology values and developments

• • • • •

Development of study

2011 – Tony Ward brought together PIs to test an alternative to NHS standardised ‘evidence-based’ practices Need for preliminary pilot data 2012 – application to BPS DCoP for funding for supervision costs Sept. 2012 – pilot study commenced Data collection completed by Dec. 2013

Structural organisation

• Multi-site study across three counselling psychology teams: UWE, Metanoia, Strathclyde/Glasgow • Principal Investigators (PIs) at each site • 3-4 practitioners per site (CPsyc student placements/staff) • Additional students collecting/using data for doctoral research projects • Data administrator based at Metanoia • Supervisor based at University of Abertay • Monthly online team meetings across sites • Documentation stored/shared via Dropbox

Recruitment

• Participants invited into study through: local publicity, student services, established clinics • Detailed information sheets provided • Invited for assessment: key inclusion criteria: PHQ-9 ≥ 10 (moderate depression) • Offered up to 24 sessions

‘Manualising’ pluralistic therapy

• Brief manual of practice drafted, with self-rated adherence scale: 1. Facilitating client-therapist collaboration through goal/task/method identification and negotiation 2. Shared understanding of clients’ goals 3. Clear about tasks being worked on 4. Effective in using appropriate methods • ‘Expert’ one-to-one supervision

Tailoring the therapeutic intervention

• Psychologists trained in a range of relational, integrative and structured principles and practices: including person-centred, CBT, psychodynamic • Assessment identifies clients’ personal goals for therapy

Goal Assessment Form

Tailoring the therapeutic intervention

• Meta-therapeutic dialogue with client on how they might achieve these goals, and preferred style of therapy • Use of Therapy Personalisation Form – Assessment

Tailoring the therapeutic intervention

• Therapists encouraged to consistently dialogue with clients re preferred goals and methods, and respond in flexible ways • Weekly Session Rating Scale (SRS) and outcome measures • Structured reviews at sessions 5 and 10, with Therapy Personalisation Form, review of goals, and meta-therapeutic dialogue

Outcome and process measures

• PHQ-9: Depression (primary outcome) • GAD-7: Anxiety • Goal Assessment Form: Personal goals • Helpful Aspects of Therapy Form: Clients’ experiences of sessions • Change Interview: Clients’ experiences of therapeutic and research process • SRS/Working Alliance Inventory/Relational Depth Inventory/Alliance Negotiation Scale: therapeutic relationship

Preliminary Data

(as of 24

th

June 2013)

Attended assessment interview: n = 49 Did not meet inclusion criteria (PHQ-9 < 10):

n

= 4, 8.2% Assessed:

n

= 45 Dropped out/unplanned ending:

n

= 11, 24.4% After assessment:

n

= 3, 6.7% During therapy,

n

= 8, 17.8% In therapy:

n

= 30, 66.7% Planned ending (by 24/6/2013):

n

= 4, 8.9%

Participants

• 75% female, 25% male • Mean age = 30.6 (range 18-58) • Approx 25% BME, 75% white European • 10% disabled • Mean PHQ-9 at assessment: 18.38 (moderately severe depression, range 9 – 25) • Mean GAD-7 at assessment: 15.48 (range 5 – 21)

Qualitative feedback

Initial change interviews (n = 3) suggest that clients appreciate PfD therapists’ flexibility and their willingness to listen to the clients’ wants and preferences, and tailor accordingly

Discussion

Challenges

• Establishing, and maintaining, consistency of protocols across sites • Need for independent auditing of pluralistic practice • Limited availability of funding • Managing and processing extensive data

Implications for counselling psychology research

• Coordinated, multi-site projects afford opportunity to develop, and rigorously test, counselling psychology interventions • Significantly enhances n /power • Attainable with limited funding • Provides basis for larger funding applications • Extensive range of potential outputs

Planned analyses/papers

ANALYSIS

Outcomes of PfD Feasibilitiy of PfD protocols Helpful aspects of PfD Helpful aspects of PfD sessions Matching between T and C ratings Case studies Helpfulness of pluralistic measures Pluralistic auditing tool Therapy Personalisation Form Analysis of session transcripts Client goals Analysis of SRS

DATA

PHQs, GADs, GAF Recruitment and retention Change interviews HATs HATs All Change interviews Therapist report forms TPF/TPF-A Session recordings Goal Assessment Forms SRS forms

Counselling psychology community: developing and promoting interventions Students: high quality supervised placements Students: conducting and publishing research Academics: conducting and publishing research; research funding

Requirements

• Focused research question • Clear organisational structure, and communication, across sites • Clear organisational structure, and communication, within sites • Clear and explicit protocols for research, practice and analysis

Pluralistic therapy for depression: Development of a multi-site research programme

DCoP Conference 2013, Cardiff

Thank you

[email protected]

www.pluralistictherapy.com