Existential Psychotherapy in the PTS

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Existential Psychotherapy in the PTS

• A qualitative and quantitative exploration of
• goals and goal attainment

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Introduction

• Existential psychotherapy
• The NHS climate
• Evidence-based psychotherapies
• Different types of evidence
• Evidence-based practice and practice-based
  evidence
• Qualitative and quantitative research
• Goals in psychotherapy

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Research questions

• What are the goals of clients receiving
  Existential Psychotherapy in the Psychological
  Therapies Service (now the Complex Care Team)?
• Is clients level of psychological distress any
  different after therapy?
• To what extent do clients feel that each of their
  goals has been met after being offered
  approximately 16 sessions of existential
  psychotherapy?
• Is the level of goal attainment linked with
  levels of psychological distress, or with number
  of sessions attended?

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Method

• Participants
• n 30, 21 women, 8 men, 1 unrecorded gender.
• Aged 19-60 years (µ 43)
• 30 white European or white other, 70 no data
• Measures
• CORE goal attainment form
• At start of therapy clients write down up to 4
  goals/difficulties they want help with.
• At end of therapy rate extent to which therapy
  helped with each difficulty/goal
• CORE-OM
• 34 items, 4 domains, overall score of
  psychological distress.
• Other measures not studied here CORE-5

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Results

• Descriptive statistics
• Average 4.5m in therapy, attended 12 sessions
  (ranging from 1 to 24 sessions).
• 20 participants attended a full course of
  therapy, for 8 therapy ended early and no data
  for 2.

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CORE-OM

• 75 of clients completed at start, 62.5 at end
  of therapy.
• Clients had significantly lower scores at the end
  of therapy than at the start, showing a reduction
  in their distress.
• Before (M 22, SE 1.4), After (M 16.50, SE
  1.5), t(19) 3.45, p .003
• CI (95) 2.16 8.84.
• Medium to large effect, d .77 or r .63.
• Reliable change (Jacobson Truax, 1991) for 20
  clients
• reliable change, less distress 11 clients (55).
• reliable change, more distress 1 client (5).
• no reliable change 8 clients (40).

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• No link between post-therapy CORE-OM scores and
  Level of goal attainment
• (for both mean and best level of goal attainment
  per client)
• But there is a link between post-therapy CORE-OM
  scores and goal attainment for Goal 1
• (Spearmans Rho -.586, p .028)
• Goal 1 is probably a clients most important goal
• No link between post-therapy CORE-OM scores and
  number of sessions attended
• (r .27, p .26).

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Goals Thematic analysis

• 25 participants wrote down a total of 77 goals (5
  participants had no goal forms).
• 60 of participants wrote down 3 or more goals.
• Length 1 to 74 words (µ 11 words).
• 6 themes, some goals in more than one theme.

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Themes and sub-themes

• 1. Self
• Acceptance
• Respect
• 2. Relationships
• Family
• Attitude
• Roles
• Independence
• Relating

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• 3. Acceptance
• Past
• Present
• Future
• 4. Making changes
• Building a future
• Embrace life
• Behaviour
• 5. Feelings
• More positive feelings
• Fewer negative feelings
• 6. Miscellaneous

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Goals quantitative analysis

• Of all 30 clients
• 83 wrote at least one difficulty at the start,
  60 (20 clients) rated a total of 57 goals at the
  end of therapy (20 goals unrated), on this scale
• How much did therapy help you with
  this difficulty?
• 0 1 2
  3 4
• Not at all A little bit
  Moderately Quite a bit Extremely
• Of these 20 clients
• most (78) wrote down three or more goals for
  therapy.

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Goal attainment All goals
13
Goal attainment per client Goal 1
14
Highest level of goal attainment per client
15
Mean level of goal attainment per client
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Discussion

• Strengths
• Combined quantitative and qualitative data
• High ecological validity
• Important time to gather this data
• Limitations
• No control group
• Incomplete data
• Small sample size
• Some goals not very detailed
• Difficulty separating themes - all interlinked
• My inexperience with Existential Psychotherapy

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• Recommendations
• Good outcomes, pat on the back!
• Continue to help clients achieve their goals,
  through Existential Psychotherapy, particularly
  their main goal (Goal 1).
• Therapists to value data collection - integrate
  more in therapy, not just tick-box exercise.
• Thorough goals at start, re-rate at end.