Jenkins, Hannah; (2018) Implementing a flexible psychotherapeutic approach (Method of Levels) in an acute inpatient setting: feasibility and acceptability. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Part 1: Literature Review - Under what conditions can the NICE guidelines Cognitive Behavioural Therapy for Psychosis be implemented? Aims: This review examined the treatment characteristics of randomised controlled trials (RCTs) investigating the effectiveness of individual Cognitive Behavioural Therapy for psychosis (CBTp). This was for the purpose of understanding if it possible to deliver National Institute for Health and Care Excellence (NICE) recommendations. Method: Nine studies were identified from three electronic databases (CINHAL, MEDLINE, and PsycINFO), from Cochrane reviews, and from meta-analyses. Studies satisfied inclusion criteria relating to: i) research design (RCT), ii) population (United Kingdom), iii) problem (psychosis), iv) intervention characteristics (individual CBTp) and v) outcome (psychosis-related). Results: There is great variation in the focus of studies, desired outcomes, and mode of delivery of the intervention. The treatment characteristics breakdown demonstrates no uniformity in terms of number, frequency, or length of sessions, nor duration of treatment. The setting and by whom CBTp was delivered varied across studies. No studies succeeded in delivering the intended number of sessions. Conclusions: The review found variation in treatment characteristics and, due to limited reporting, it is difficult to draw conclusions regarding the best way to implement CBTp. The review highlighted the difficulty in implementing a structured treatment protocol in NHS settings, and indicated that a blanket recommendation of sixteen sessions of CBTp is simplistic, failing to address both the complexities of psychosis, and the realities of service delivery in the NHS. Further research looking at the feasibility of implementing treatments for psychosis is needed, with clearer reporting of treatment characteristics. Part 2: Empirical Paper - Implementing a flexible psychotherapeutic approach (Method of Levels) in an acute inpatient setting: feasibility and acceptability. Aims: This study sought to investigate the feasibility and acceptability of sessional therapists implementing a flexible psychotherapeutic approach (the Method of Levels - MOL) on an acute mental health inpatient ward. Method: Mixed methods was used. Quantitative analysis assessed the feasibility of implementation by investigating the attendance patterns of participants, usage of therapeutic resources offered by therapists, and the ability of therapists to adhere to the MOL approach following training and ongoing supervision. Acceptability of MOL was explored using a thematic analysis (Braun & Clarke, 2006) of participant interviews and by recording attendance patterns of participants. Results: The data indicates that it was feasible to implement an MOL intervention when sessional therapists attended the ward one day a week. Quantitative data indicates that therapists are able to learn, use and adhere to an MOL approach in an acute setting. Thematic analysis of participant experience of the therapy generated domains which spoke to participants’ experience of being in the NHS, participants having spent meaningful time with the therapist, and having gained something from the session. Conclusions: The data indicates that the delivery model is feasible to implement and was acceptable to most participants when therapists were adequately trained and supervised. Using sessional therapists would not be a financially viable recommendation when compared to routine psychological input. Qualitative analysis indicates that overall, there was a shared, humanising experience of therapy, but it is unclear whether this was due to MOL specifically. A randomised control trial is required to compare MOL to other therapies and build on findings.

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