Pluralistic therapy for depression:
Development of a multi-site
research programme
DCoP Conference 2013, Cardiff
Research team
University of Strathclyde/Glasgow: Mick Cooper (PI), Simon Cassar,
Pavlina Antoniou, Ayse Suzan Aylindar, Jackie DiCroce, Missy
Iqbal, Maria Michalista, Fani Papayianni, Shilpa Sreenath
Metanoia Institute: Biljana van Rijn (PI), Ciara Wild (Admin), Sunny
Barnes, John McAteer, Stratis Pasdekis, Lia Foa, Adrian
Tempier
University of West of England: Tony Ward (PI), Carole Francis-Smith,
Charlotte Mcevoy, Eleanor Brown, Naomi Moller
University of Abertay: John McLeod
Aims
• Describe the development of a multisite study for evaluating the outcomes
of a counselling psychology
intervention: pluralistic therapy for
depression
• Provide preliminary data on
participants and outcomes
Pluralistic therapy
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•
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Strives to transcend ‘schoolism’ in psychological
therapies
Collaborative-integrative practice: draws on range of
approaches and methods to tailor therapy to the
individual client
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
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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
th
24
June 2013)
Participant flow chart
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%
Planned ending (by 24/6/2013): n = 4, 8.9%
In therapy: n = 30, 66.7%
Participants
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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
Students: high quality
supervised placements
Synergies
Counselling psychology
community: developing
and promoting
interventions
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
Mick.cooper@strath.ac.uk
www.pluralistictherapy.com