A discourse analysis of power in relation to PSYCHLOPS (Psychological outcome profiles) in the context of CBT for psychosis

Abstract

Aims: Outcome measures (OMs) and routine change measurement have developed dramatically in psychological therapies over the last two decades and some therapists have expressed concerns that this, depending on how it is handled by the parties involved, can markedly affect the therapy. However, little research has investigated this. It therefore seemed timely to explore discourses of OMs drawn upon by both parties in the therapy room. Method: PSYCHLOPS (Psychological Outcome Profiles) is a client-centred measure which offered an opportunity to explore how therapists and clients receiving CBT for psychosis talked about OMs. A useful contrast was provided by the CORE-OM (Clinical Outcomes in Routine Evaluation-Outcome Measure). The discourses drawn upon by clients (n 04) and therapists (n 04) were analysed, informed by a Foucaultian framework. Results: OMs were constructed as empowering or disempowering of clients, as being able to do therapeutic work of engagement and containment, and as part of the apparatus of service power, positioning therapists as relatively powerless to question their use. Discussion: It is suggested that client-centred measures like PSYCHLOPS, although partly aligned with a recovery framework, may become part of top-down state and service power, and there is a need for more research into the different ways in which OMs are used in therapy and the impacts on therapists, clients and their relationships.

Clients with different problems are different and questionnaires are not blood tests: A template analysis of psychiatric and psychotherapy clients' experiences of the CORE‐OM

“…A number of such studies have focused on the widely used CORE‐OM measure (Evans et al, ; Evans et al, ) and include work in inpatient (Alves, Sales, & Ashworth, ; Guerra et al, ; Perry, Barkham, & Evans, ) and outpatient settings (Börjesson & Boström, ; Kelly, Holttum, Evans, & Shepherd, ), with methods including semi‐structured interviews and focus groups, and with different epistemological and theoretical approaches. Themes that appeared in these studies concerned understanding the measures, their purpose and consequences for treatment, and the characteristics of the staff member who offered the measure [CORE‐OM] to the patient.…”

“…A frequent comment of staff from psychiatric services is that self‐report questionnaires are not really applicable for their clients because the clients’ experiences, particularly psychotic experiences, are such that their self‐appraisals are not comparable with those of clients seeking psychological therapies rather than psychiatric support, or clients seeking psychotropic medication from generalists in “primary care”. However, the above‐mentioned qualitative studies indicate that these patients conceive CORE‐OM as a valuable element of the therapeutic process (Guerra et al, ), that is easier to understand and respond to than client‐generated outcomes (Kelly et al, ). The typical chronicity of this population's problems and their not‐infrequent institutionalisation and dependency may also affect how they experience self‐report measures.…”

“…One purely quantitative exploration (Barkham, Gilbert, Connell, Marshall, & Twigg, ) reported psychometric explorations of the CORE‐OM in both primary care and secondary care in the UK, but it would appear that few, if any, of the secondary care participants had psychotic experiences and all secondary care participants were receiving psychological therapies. Of the five qualitative studies of the CORE‐OM listed above, four were conducted in psychiatric hospital settings and three included participants who had a diagnosis within the schizophrenia spectrum (Alves et al, ; Guerra et al, ; Kelly et al, ; Perry et al, ). Hence, most qualitative studies of client's experiences of the CORE‐OM have neglected the experience when using outcome and change measures of participants in other nonhospital settings and not presenting psychotic experiences.…”

The development and testing of PSYCHLOPS Kids: a new child‐centred outcome measure

“…We therefore decided to adapt one of the most commonly used adult client generated measures, PSYCHLOPS (Psychological Outcome Profiles) (Ashworth et al., ). It has been validated for use in adult mental health interventions in primary care, community and secondary care mental health settings (Ashworth et al., ; Hedinsson, Kristjansdottir, Olason, & Sigurdsson, ; Kelly, ). PSYCHLOPS is included in the list of mental health outcome measures approved by the UK Department of Health (National Institute of Mental Health in England, ).…”

Therapy talk and talk about therapy : Client-identified important events in psychotherapy

“…Griffiths, 2001;Larsson, Loewenthal, & Brooks, 2012;Moore & Rae, 2009;Stevens & Harper, 2007), and how discourses shape the experiences and views of clients and patients (e.g. Burns & Gavey, 2004;Kelly, Holttum, Evans, & Shepherd, 2012;Swann & Ussher, 1995).…”