Development of Pluralistic Therapy for Depression Study

This research program focuses on evaluating the outcomes of pluralistic therapy for depression, aiming to transcend traditional psychological therapy approaches by tailoring treatments to individual clients through collaborative-integrative practices. The project involves multiple university research teams and practitioners, with a structural organization across different sites to collect and analyze data for doctoral research projects. Participants are recruited through local publicity and student services.

• Pluralistic Therapy
• Depression Study
• Collaborative Integrative Practice
• Research Programme
• Counselling Psychology

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1. 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

2. 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

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. 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

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: 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

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 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%

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 ANALYSIS DATA 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 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

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 programme DCoP Conference 2013, Cardiff Thank you Mick.cooper@strath.ac.uk www.pluralistictherapy.com