title of presentation counselling for depression competence based person- centred experiential...

Title of Presentation

Counselling for Depression Competence Based Person-Centred Experiential Therapy

(CfD) IAPT Recruitment Fair

London 2015


1

Introduction to CfD


What is CfD?• Counselling for Depression is an

‘evidence-based’ form of psychological therapy recommended by NICE for the treatment of depression

• It is a person-centred, experiential model, based on a framework of research-derived competences


3 trials of Person-Centred Therapy

2 trials comparing Person-Centred with EFT

1 trial of Process/Experiential Therapy (EFT)

Acknowledging this evidence, CfD integrates aspects of EFT with PCT


• A person-centred and experiential therapy with strong links to contemporary research:

• Bedi, N., Chilvers, C., Churchill, R., et al (2000) • Friedli, K., King, M.B., Lloyd, M., et al. (1997) • Goldman, R.N., Greenberg, L.S. & Angus, L. (2006) • Greenberg, L.S. & Watson, J. (1998) • Marriott, M. & Kellett, S. (2009) • Watson, J.C., Gordon, L.B., Stermac, L., et al. (2003)


What is CfD?• As a collaborative and person-centred form of therapy it

recognises that individual clients will not only present differing levels of problem severity but also have varying levels of personal capacity and social resources available to them

• Hence the number of sessions needed for clients to achieve their therapeutic goals will vary accordingly

• Between 10 and 20 sessions recommended tailored to the needs of the individual client

(ref:National Institute for Health and Clinical Excellence (May 2011) Clinical Guideline 123)


Stepped Care


Implementing Evidence-Based Psychological Therapies

• Therapies delivered in research trials are often manualised and adherence to the manual is monitored

• Routine practice is non-manualised, carried out by therapists with varying levels of training

• Experienced therapists tend to deviate from tenets of their initial training

• Qualifications and professional title alone are not therefore evidence of proficiency in an evidence-based therapy


IAPT NICE Approved Additional Modalities

• Counselling for Depression (CfD)• Dynamic Interpersonal Therapy (DIT)• Interpersonal Therapy (IPT)• Behavioural Couples Therapy (BCT)

Each with a research derived,

competence framework to describe them


Structure of the framework

Generic competences

Basic competences

Specific competences

Meta-competences


• It is estimated up to 35% of therapists in IAPT are counsellors; High intensity practitioner training in the additional approved modalities helps ensure they are recognised as being trained in an evidence-based therapy. A conservative estimate (2012 IAPT census) is that 828 counsellors in IAPT are in this position.


Significance of CfD:-• It helps to secure the provision of

counselling in IAPT, ensuring that counselling is provided free at the point of access to NHS patients and that the status of counsellors in IAPT is recognised

• Strong links between research, training and practice will help secure evidence-based status and support choice for users of NHS psychological services


2

Description of CfD Training


What does CfD training involve?

• 5 day top-up/CPD• Assessed video on course completion • 80 hours of supervised practice with CfD

supervision• 4 audio recordings of clientwork assessed

as adhering to the CfD competences • Development of practice through feedback• Certification and counts towards BACP

Accreditation & Senior Accred


Evaluation Research into Participant’s Experience of the CfD Training

• All participants in the first wave of training nationally were emailed a questionnaire to complete online

• Those completing the survey were asked if they would be prepared to take part in follow-up telephone interviews which were transcribed and analysed using thematic analysis


If you feel the training has impacted on your practice please provide further information as to how

• It’s developed my use of the focus on emotions and made me interested in learning more of EFT

• It’s re-juvenated my confidence in the effectiveness of the person-centred approach

• In my organisation I am more valued and this has had an impact on practice

• The training was a useful reminder of working in the PCE approach within a short-term model – less is more

• It reminded me of my person-centred roots and brought me back to that where over the past few years I had been more integrative

• I don’t think the training improved my practice. What it did do was to allow me to reaffirm what I have been doing and what I continue to do.


Conclusions• Enhancing status was an important

motivation for undertaking the training• Experience of training and supervised

practice generally very positive• Competence framework accurately

describes PCE therapy and is appropriate for working with depressed clients


Impact of the training:• Training has enhanced status and

increased confidence• Working to competencies and having

adherence measure viewed as a positive process

• Training has changed how therapists practice


3

Distinctive Features of CfD: Issues for

Discussion


Adhering to the competence framework

Use of the PCEPS scale


Conceptualising depression from a PCE perspective


The relationship between self-aspects

Personality is composed of many inter-related self aspects. Problems occur when one aspect:

• is excessively critical of another• constantly suppresses another• regularly interrupts another• experiences the absence of another


Self-discrepanciesREAL SELF: the self as one sees oneself

IDEAL SELF: the self as one would like to be in one’s own eyes

OUGHT SELF: the self as one believes others think one ought or should be


Real self

Real selfOught

self

Ideal self


Discrepancy between selves associated with anxiety and depression:

Watson and Bryan (2010)


Integrating the Specific Competences

• Ability to help clients to access and express emotions

• Ability to help clients articulate emotions • Ability to help clients reflect on and

develop emotional meanings • Ability to help clients make sense of

experiences that are confusing and distressing


Future Developments for CfD• CfD Evaluation Project –Therapy Today

December 2012 • BACP commissioning RCT comparing of

CfD with CBT(£450K)• Use of competences in other areas of

research and practice (i.e. schools counselling)

• CfD Textbook commissioned by BACP and Sage publications


Thank you for participating

Peter PearceHead of Person-Centred Dept. Metanoia Institute

[email protected]

And

Ros SewellTutor MSc. Person-Centred Psychotherapy

Metanoia Institute and Accreditation Assessor BACP

mailto:[email protected]


Controversies• Directivity? “It isn’t PC to direct a client to emotion!”

• Manualisation? “ I work intuitively and you are turning me

into an automaton!”

• Resistance to change? “I didn’t think there was anything CfD could teach me about being a PC therapist!

• Examining our practice? “I feel like I’ve gone back to being a student!”

• Invading the sacred space? “This isn’t how I usually practice….my client and I were conscious of the recorder in the room!”


Counselling for DepressionRationale for selection of Humanistic framework:-• 72% of BACP members report having trained in

either Humanistic or Person-centred counselling (PCC)

• Counselling in primary care research:– 2 systematic reviews include PCC, plus other

interventions– 2/4 trials tested PCC

(Hill et al, 2008)


NICE Guideline• Bedi, N., Chilvers, C., Churchill, R., et al (2000) • Friedli, K., King, M.B., Lloyd, M., et al. (1997) • Goldman, R.N., Greenberg, L.S. & Angus, L. (2006) • Greenberg, L.S. & Watson, J. (1998) • Marriott, M. & Kellett, S. (2009) • Watson, J.C., Gordon, L.B., Stermac, L., et al. (2003)

3 trials of Person-centred therapy

2 trials compare Person-centred with EFT

1 trial of Process/experiential therapy (EFT)

title of presentation counselling for depression competence based person- centred experiential...

Documents

cfd slide

evidence based therapy

evidencebased therapy

professional title

pct slide

care slide

personcentred form of

framework of research