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Title of Presentation
Counselling for Depression Competence Based Person-Centred Experiential Therapy
(CfD) IAPT Recruitment Fair
London 2015
Title of Presentation
1
Introduction to CfD
Title of Presentation
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
Title of Presentation
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
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• 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)
Title of Presentation
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)
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Stepped Care
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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
Title of Presentation
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
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Structure of the framework
Generic competences
Basic competences
Specific competences
Meta-competences
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• 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.
Title of Presentation
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
Title of Presentation
2
Description of CfD Training
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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
Title of Presentation
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
Title of Presentation
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.
Title of Presentation
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
Title of Presentation
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
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3
Distinctive Features of CfD: Issues for
Discussion
Title of Presentation
Adhering to the competence framework
Use of the PCEPS scale
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Conceptualising depression from a PCE perspective
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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
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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
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Real self
Real selfOught
self
Ideal self
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Discrepancy between selves associated with anxiety and depression:
Watson and Bryan (2010)
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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
Title of Presentation
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
Title of Presentation
Thank you for participating
Peter PearceHead of Person-Centred Dept. Metanoia Institute
And
Ros SewellTutor MSc. Person-Centred Psychotherapy
Metanoia Institute and Accreditation Assessor BACP
Title of Presentation
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!”
Title of Presentation
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)
Title of Presentation
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)