ObjectivesThe aim of this study was to assess the outcomes, acceptability and helpful aspects of a pluralistic therapeutic intervention for depression.DesignThe study adopted a multisite, non-randomised, pre-/post-intervention design.MethodsParticipants experiencing moderate or more severe levels of depression (as assessed by a score of 10 or greater on the Patient Health Questionnaire depression scale, PHQ-9) were offered up to 24 weeks of pluralistic therapy for depression. This is a collaborative integrative practice oriented around shared decision making on the goals and methods of therapy. Of the 42 participants assessed, 39 (92.9 per cent) completed two or more sessions. Participants were predominantly female (N=28, 71.8 per cent) and white (N=30, 76.9 per cent), with a mean age of 30.9. The principal outcome indicator was improvement and recovery on the PHQ-9 and Generalised Anxiety Disorder 7-item (GAD-7) scale.ResultsOf the completer sample, 71.8 per cent of clients (N=28) showed reliable improvement and 43.6 per cent (N=17) showed reliable recovery. Effect sizes (Cohen’s d) from baseline to endpoint were 1.83 for the PHQ-9 and 1.16 for the GAD-7. On average, the clients found the PfD sessions helpful and valued the flexibility and collaborative approach of their therapists. Clients felt that change had been brought about by their own active engagement in therapy and through the therapists relational qualities, as well as their use of techniques.ConclusionsInitial indications suggest that pluralistic therapy for depression has acceptable outcomes, retention rates, and user satisfaction. Refinement and further testing of the approach is recommended.
Aim The purpose of this study was to examine clients’ perspectives regarding the helpful aspects of pluralistic therapy for depression. Method Thirty‐nine clients received psychological treatment in a multi‐site study exploring alternative interventions to standardised ‘evidence‐based’ approaches. Eighteen of them consented to a face‐to‐face or telephone change interview at the end of their treatment. Change interviews aim to elicit clients’ perspective regarding changes that they noticed during, and after, therapy and also the possible causes of these changes. Their descriptions were transcribed and analysed thematically using explicit coding of themes which were audited by the research team. Findings The data were categorised in three a priori domains consisting of specific themes. The first domain constitutes of client‐originated helpful factors including clients’ positive perspectives of therapy, clients’ overall effort to change and clients’ contribution in the decision‐making process of therapy. Therapists were perceived as helpful when they were accepting and respectful, empathic, responding to clients’ needs, making clients feel comfortable, challenging, empowering, using techniques, flexible and reassuring. Treatment outcomes such as change in perspectives, behaviour and response to problems as well as increased insight were also considered helpful factors of therapy. Conclusion These findings suggest that clients in pluralistic therapy are active agents of change and their willingness to engage with treatment is crucial. Helping clients feel comfortable by creating a safe therapeutic environment, challenging dysfunctional patterns associated with depression and empowering them to believe that change is possible through reassurance and non‐intrusive guidance were considered beneficial.
BackgroundResearch data suggests that eating disorders symptomatology is determined by the individual’s unique combination of biological and psychological factors, in relation to their familial and social backgrounds (Brumberg, 2000). This means that different clients may benefit from different psychological interventions (Lock et al., 2010).PurposeThis systematic review investigates the significance of the quality of the therapeutic alliance for the effectiveness of psychological treatments with eating disorders.MethodA review of electronic databases was conducted against pre-determined exclusion and inclusion criteria, with applicable studies been abstracted using the PRISMA four-phase flow diagram (Moher et al., 2009). Nine quantitative and two qualitative studies which were published prior to June 2012 were included, and their data are critically considered and analysed.FindingsThe quality of the therapeutic alliance is significantly associated with the success of treatment outcome for anorexia nervosa, although its importance remains unclear for bulimic individuals.DiscussionPossible reasons behind the ambiguity of the results are discussed, and alternative contributors to successful treatment outcomes are incorporated.ConclusionNotwithstanding the fact that this systematic review encountered a number of limitations, the findings could inform practice as well as form the basis for additional research in the field of eating disorders.
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