UK national guidance has prioritized developing specialist services for first episode psychosis. Such services are in the early stages of development and a definitive treatment model has yet to be established. The aim of this study was to explore service users' experiences of a first episode intervention designed along evidence-based 'best practice' guidelines and to establish specific elements seen as effective to help inform future service planning and provision. Twelve users of a specialist first episode service participated in focus groups. These were then analyzed using Interpretative Phenomenological Analysis, a specialized form of content analysis. Key elements identified by the service users included the 'human' approach as a key to the recovery process, being involved in treatment decisions, flexibility of appointments, high nurse to patient ratio, reduction in psychotic symptoms, increased confidence and independence and the provision of daily structure. To our knowledge, this is the first systematic qualitative evaluation of users' experience of a specialist first episode treatment intervention. Our findings indicate that adherence to best practice guidelines was appreciated. Regular focus groups provide a continuous audit cycle incorporating service improvements in line with government recommendations, centrally informed by the service users' and caregivers' perspective.

Definitions of treatment failure and the labelling of patients as non-responsive typically require treatments to have been offered and failed. For pharmacological treatments, treatment quality is relatively easy to define; this is much more difficult with psychological treatments. This study examined patient recollections of previous therapy for obsessive compulsive disorder (OCD). A Treatment History Questionnaire was administered to a sample of 57 apparently treatment refractory OCD patients from a specialist national OCD treatment unit and a national charity for OCD sufferers. On average, respondents reported an 8 1 2 year wait between the obsessional symptoms interfering significantly with their lives and being diagnosed. Forty-three percent recalled having received either cognitive behaviour therapy (CBT) or behaviour therapy as the first treatment; 31% of the group did not know what type of therapy they had received. The components of therapy that respondents recalled were analysed and contrasted with minimal therapy criteria. These criteria appear not to have been met in most patients who understood that they had received "CBT". The implications of this study for assessment of treatment integrity and the classification of patients as "treatment resistant" are discussed.

People with obsessive-compulsive disorder (OCD) are likely to be more susceptible to the mental health impact of COVID-19. This paper shares the perspectives of expert clinicians working with OCD considering how to identify OCD in the context of COVID-19, changes in the presentation and importantly what to consider when undertaking Cognitive Behaviour Therapy (CBT) for OCD in the current climate. The expert consensus is although the presentation of OCD and treatment may have become more difficult, CBT should still continue remotely unless there are specific reasons for it not to e.g. increase in risk, no access to computer or exposure tasks or behavioural experiments cannot be undertaken. The authors highlight some of the considerations to take in CBT in light of our current understanding of COVID-19, including therapists and clients taking calculated risks when developing behavioural experiments and exposure tasks, considering viral loading and vulnerability factors. Special considerations for young people and perinatal women are discussed as well as foreseeing what life may be like for those with OCD after the pandemic is over.

An intensive treatment format for the delivery of CBT for OCD was found to be as effective as weekly treatment. This is consistent with the recommendations from the National Institute for Clinical Excellence guidelines. This study adds to the growing literature on the effectiveness of intensive format treatment.

This chapter explores goal-oriented practice across therapies: cognitive behaviour therapy (CBT), psychoanalytic psychotherapy, psychoanalytic child psychotherapy, interpersonal psychotherapy (IPT), humanistic and existential therapies, systemic family therapy, and online therapy. Each section gives an overview of the approach and sets out ways that goals are conceptualized, negotiated, and embedded. Examples are given to illustrate how goals are used. Differences are found across these approaches in the methods used to negotiate goals, and the extent that these are made explicit and embedded in the work. Greater similarities are found in the use of goals in CBT and IPT, compared with the less directive modalities of humanistic, psychodynamic, and systemic psychotherapies. Differences are also found within modalities (e.g. psychoanalytic psychotherapy for adults versus psychoanalytic child psychotherapy). However, the chapter demonstrates the many similarities in the use of goals as a common factor across these different therapeutic approaches.