Clients’ experiences of one‐to‐one low‐intensity interventions for common mental health problems: An interpretative phenomenological analysis

Abstract

ObjectivesCommon mental health disorders such as depression and anxiety are highly prevalent and carry significant health care and economic burdens. The UK's improving access to psychological therapies (IAPT) initiative was developed as a cost‐effective way of reducing the pernicious effects of these disorders. IAPT interventions, such as guided self‐help, have been subjected to considerable quantitative evaluation. However, there has been minimal investigation into clients’ experiences of the one‐to‐one low‐intensity interventions (LIIs), which form a key component of IAPT service provision. Qualitative exploration could provide rich data regarding experiences of psychological change and factors affecting therapeutic experiences. This will enable informative, client led insights into how low‐intensity therapy can be improved.MethodsInterpretative phenomenological analysis of eight semi‐structured interviews was used to develop an idiosyncratic understanding of clients’ experiences of one‐to‐one LIIs following entry into a randomized control trial (RCT).ResultsFour superordinate themes were identified from clients’ accounts: goals and expectations of therapy, beneficial aspects of therapy, non‐beneficial aspects of therapy, and the experience of psychological change. A heuristic model of interrelationships between factors is proposed.ConclusionsBoth therapeutic techniques and relationships contribute to beneficial therapeutic experiences. The results reported here can be used to inform practice by harnessing the most beneficial aspects of therapy, such as developing adaptive therapeutic approaches to clients’ clinical needs and facilitating idiosyncratic processes of psychological change. Due to limited qualitative research in this area, further research should be conducted in different service settings to assess differences and similarities in clients’ experiences.Practitioner points Therapists who adapted to clients’ individual needs were perceived as more effective than those who did not.Effective therapeutic experiences were exemplified by a personal therapeutic approach, enough time to discuss issues and normalizing client's experiences.Clients develop idiosyncratic models of change which should be encouraged by therapists over and above clinical models.

Service users experience of psychological interventions in primary care settings: A qualitative meta‐synthesis

“…The limitations of interventions and suggested improvements for services development were reported in more than half of studies. Suggestions for improving structural aspects of interventions included more sessions (Amos et al, 2019; Bahu, 2019; Bendelin et al, 2011; Leonidaki et al, 2016; Goldman et al, 2016), greater contact with practitioners (Bendelin et al, 2011; Haller et al, 2019; Holst et al, 2017; Knowles et al, 2015; Rushton et al, 2020), and further activities with group members (Bahu, 2019). Different suggestions on how and whether to complete outcome measures were also expressed in one study (Rushton et al, 2020).…”

“…Stigma was mentioned in 50% of articles. Self-stigma and social stigma were described as hindering help-seeking and willingness to share difficulties with others (Allen et al, 2009;Amos et al, 2019;Bahu, 2019;Christodoulou et al, 2018;Foy et al, 2019;Millett et al, 2018;Newbold et al, 2013):…”

“…Nearly all articles highlighted the importance of practitioners' qualities and skills (Amos et al, 2019;Bahu, 2019;Christodoulou et al, 2018;Doukani et al, 2020;Farrand et al, 2018;Foy et al, 2019;Goldman et al, 2016;Hadfield et al, 2019;Haller et al, 2019;Leonidaki et al, 2016;Lillevoll et al, 2013;Mackinnon & Murphy, 2016;Millett et al, 2018;Rushton et al, 2020).…”

Effectiveness of Briefer Coping-Focused Psychotherapy for Common Mental Complaints on Work-Participation and Mental Health: A Pragmatic Randomized Trial with 2-Year Follow-Up

“…Likewise to the previously mentioned LBP trials [21][22][23][24], in the briefest group the focus was narrow and aimed mainly at normalization of symptoms, redirecting patients' concerns, restoring confidence, acceptance of and adaptive coping with the patient's most prominent problem. The beneficial aspects of normalization in low intensity therapy of subjects with common mental health disorders has been confirmed previously in a quantitative study [63]. It seems therefore timely to ask whether it might be the differences in the focus of the therapy that explain the group-differences in clinical recovery.…”

The 4Ds of Dealing With Distress – Distract, Dilute, Develop, and Discover: An Ultra-Brief Intervention for Occupational and Academic Stress

“…There is also evidence that having control over stressful experiences, such as facing a fear, is beneficial (Healey et al, 2017). When users are interviewed about how they utilized existing interventions, they commonly report selecting and personalizing the strategies and insights that they find relevant to their own specific situation (Amos et al, 2019;Warwick et al, 2019). Building on these features, when clients are given the control to book their own timing and duration of appointments, the benefits include a reduced waiting list (Carey and Spratt, 2009) and a greater efficiency of the intervention relative to benchmarked studies (Carey et al, 2013).…”