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Existential Psychotherapy in the PTS

Existential Psychotherapy in the PTS. A qualitative and quantitative exploration of goals and goal attainment. Introduction. Existential psychotherapy The NHS climate Evidence-based psychotherapies Different types of evidence Evidence-based practice and practice-based evidence

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Existential Psychotherapy in the PTS

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  1. Existential Psychotherapy in the PTS A qualitative and quantitative exploration of goals and goal attainment

  2. 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

  3. 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?

  4. 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

  5. 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.

  6. 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%).

  7. 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 • (Spearman’s Rho = -.586, p = .028) • Goal 1 is probably a client’s most important goal • No link between post-therapy CORE-OM scores and number of sessions attended • (r = .27, p = .26).

  8. 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.

  9. Themes and sub-themes • 1. Self • Acceptance • Respect • 2. Relationships • Family • Attitude • Roles • Independence • Relating

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

  11. 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.

  12. 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

  16. 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

  17. 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.

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