The Future of Psychotherapy in Ireland. A Delphi Study Overview What is my research interest? The Vision for Change document The available (non) Data Issues in treatment What is a Delphi study? Why use it for this piece of research? The method for this research The statements and questions being considered Feedback Research Interest and Motivation Accredited psychotherapist working in private practice Business background Reflecting on the future of psychotherapy It is administered professionally but is it a profession? Viability of psychotherapy as a profession Pre-eminence of GPs at entry into primary care I would like my research to inform practice and policy The Vision for Change document (Terms such as psychotherapist and counsellor are not legally protected – the industry is self-regulated) 2006 policy document produced by the Irish Government in order to provide a framework for future mental health services in the state Much of the data used is UK originating data There is little exploration of a rationale for the current structures or for the proposed structures Vision for Change (contd.) “mental health problems are indicated in as many as one in four primary care consultations (Goldberg 1991, p. 62) making mental health second only to consultations for respiratory infection (McCormick, Fleming and Charlton 1995, p. 62). “ “Nine out of ten mental health problems are dealt with in primary care without referral to a specialist mental health service.” Mental health presentations are important and are often retained in GP care Vision for Change (contd.) While Vision for Change claims to being supportive of a biopsychosocial model (p. 18) on reading the document it is clear that in practice this is not the case GPs are the most powerful group in mental health primary care and will remain so The available data The Vision for Change document acknowledges a lack of Irish data How can we make policy decisions without domestic data? I have made some tentative attempts at some numbers related to the field in Ireland We have one of the highest ratios of accredited therapists per head of population in the world Issues in treatment Medication Medical diagnosis and labelling Statutory regulation Training of psychotherapists and professional standards Low cost counselling and impact on profession What is a Delphi study? Dalkey (1969): the Delphi approach was derived through experimentation at the RAND Corporation He recommends the use of this kind of study “in areas of broad or long-range policy formulation” including “social development.” (p. iii) Used in health policy development What is a Delphi study? A panel of experts is established They participate confidentially and anonymously (problems with focus groups) The process involves “controlled feedback” through feeding back information to participants through a series of rounds after each of which information from the process is collated, analysed and issued to participants for the next round until completion (p. 16) Contributions are weighted by the contributors Why use it for this research? I focus on narrative in my work I have a qualitative world view However categorisation and formal frameworks are useful and sometimes necessary The Delphi can bridge between a qualitative perspective and a practical response The Delphi in my research It is envisaged that my research will be done via email It is important to review and feedback to participants promptly Delphi statements and questions Position 1 There are a number of different accrediting and representative bodies for psychotherapy and counselling practitioners in Ireland. Many of these have different theoretical approaches, academic requirements and practice hour obligations for membership and or practice. The use of the title counsellor or psychotherapist is not protected in law and in effect anyone can use the term. Currently it is envisaged that many of the self-regulating bodies in the mental health field will ultimately be brought under a statutory umbrella and terms like “Psychological Therapist – Psychotherapist” will be legally protected. 1.1 What is your expectation around how the statutory regulation might evolve? 1.2 How would you like to see this process evolving? 1.3 What kind of training standards and accreditation requirements would you see as important and why? Delphi statements and questions Position 2 Up to 30% of presentations in General Practice (i.e. presentations to medical doctors in general practice) are for mental distress. From these a small percentage of referrals to mental health practitioners (such as psychiatrists, psychologists, psychotherapists or counsellors for example) are made. 2.1 How do you see the role of GPs in primary care for mental health issues in Ireland evolving? 2.2 How would you like to see this role evolving? 2.3 In your experience of counsellors and psychotherapist in Ireland what are your observations in relation to the standards of their practice and how you envisage this could evolve? Delphi statements and questions Position 3 In the USA the use by psychiatry of psychotropic medicine in response to mental distress presentations has increased at the same time that the use of psychotherapy in psychiatry has declined. There is an increasing reliance on psychotropic medication in primary care worldwide and many GPs are uncomfortable with the prevalence of primarily medication based interventions. Arguably research is suggesting that a combination of medication and psychotherapy is effective. Other research is emerging suggesting that some psychotropic medications are not as effective as it has been claimed and in separate research that adherence is poor. 3.1 How do you see the use of medication relative to psychotherapy evolving in Ireland? 3.2 If you could envisage the possibility of an alternative but realistic change or changes in this context, what would these be? Feedback and Questions Bibliography Boyatzis, R. 1998. Transforming qualitative information. Thematic analysis and code development. California: Sage Publications. Dalkey, N. 1969 The Delphi Method: An experimental study of group opinion http://18.104.22.168/content/dam/rand/pubs/research_memoranda/2005/RM5888.pdf California: Rand [Downloaded 31 March 2011] Dallos, R., Veter, A. 2005. Researching Psychotherapy and Counselling. Berkshire: Open University Press. Fox, M., Martin, P., and Green, G. 2010. 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Annual Conference Book of Abstracts http://www. psychotherapy-ireland.com/wp-content/uploads/2012/01/18JanBook-of-Abstracts.pdf [Downloaded 20 May 2012] Kingdon, D. 2004. ‘An introduction to psychotherapeutic perspectives in primary care: a qualitative and subjective observation on underlying clinical trends in common mental health problems.’ Primary Care in Mental Health vol. 2, pp. 157-64. Knight, L. 2003. ‘Research Report: How do GPs make referral and treatment decisions when patients present with mental health problems’, Counselling Psychology Quarterly, vol.16, pp. 195-221. Marks, I. and Cavanagh, K. 2009. Computer-aided psychological treatments: evolving issues. Annual Review of Clinical Psychology, 5pp.121-141. McCormick, A., Fleming, D. and Charlton, J. 1995. ‘Morbidity statistics from general practice’. Fourth national study 1991-1992. London, HMSO, series MB5, no. 3. cited in Report of the Expert Group on Mental Health Policy p. 62. McCullagh, A. 2010. Client, GP and Counselling Psychologists attitudes to seeking psychological help within primary care. MSc in Counselling Psychology, Trinity College, University of Dublin. (Unpublished). McLeod, J. 2003. Doing Counselling Research. 2nd ed. London: Sage. McQueen, D., Pennybacker, T. and Doctor, R. 2010. Complexity of referrals to a specialist psychotherapy service. Psychoanalytic Psychotherapy, 24(2), pp.168-173. Merton, R. and Kendall, P. 1946 The Focused Interview. American Journal of Sociology, Vol. 51, No. 6 (May, 1946), pp. 541-557. Published by: The University of Chicago Press Available from: http://www.jstor.org/stable/2770681. [Accessed on 20 May 2012] Stewart, D, Shamdasani, P. and Rook, D. 2007. Focus groups: Theory And Practice 2nd ed.Applied Social Research Methods Series Vol. 20. California: Sage. Siggins, L. 2012. Lynch affirms commitment to mental health strategy. The Irish Times [Online] Monday, May 14, 2012 Available from: http://www.irishtimes.com/newspaper/ireland/ 2012/0514/1224316065531.html [Accessed 23 May 2012] Sundlov, E. 2008. Factors influencing GPs in their decision to refer patients with mental health problems to a mental health professional. An exploratory study. MSc in Counselling Psychology Thesis, Trinity College Dublin (Unpublished). The Government of Ireland, 2006, A Vision for Change, Report of the Expert Group on Mental Health Policy, Dublin, The Stationery Office. Turoff, A. 1970, The Design of a Policy Delphi, Technological Forecasting and Social Change 2, No.2 Ward, D. 2011. Primary factors involved in referral from general practitioners to psychological therapies. A review of the literature. MSc in Psychotherapy Studies. University of Sheffield.