Pluralistic therapy for depression: Development of a multi-site research programme DCoP Conference 2013, Cardiff

1. Pluralistic therapy for depression: Development of a multi-site research programmeDCoP 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, FaniPapayianni, ShilpaSreenath Metanoia Institute: Biljana van Rijn (PI), Ciara Wild (Admin), Sunny Barnes, John McAteer, StratisPasdekis, LiaFoa, Adrian Tempier University of West of England: Tony Ward (PI), Carole Francis-Smith, Charlotte Mcevoy, Eleanor Brown, Naomi Moller University of Abertay: John McLeod

2. 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 Aims

3. Pluralistic therapy 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

4. 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 Development of study

5. 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

6. 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

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

8. 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

9. Goal Assessment Form

10. 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

12. 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

13. 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

14. Preliminary Data(as of 24th June 2013)

15. Participant flow chart

16. 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)

17. 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

18. Discussion

19. 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

20. 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

21. Planned analyses/papers

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

23. 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

24. Pluralistic therapy for depression: Development of a multi-site research programmeDCoP Conference 2013, Cardiff Thank you Mick.cooper@strath.ac.uk www.pluralistictherapy.com