Pilot service evaluation of a brief psychological therapy for self‐harm in an emergency department: Hospital Outpatient Psychotherapy Engagement Service

Abstract

Background Brief psychological therapies may be helpful for people who have recently self‐harmed. The current paper reports on a service evaluation of a novel brief therapy service based within an Emergency Department, Hospital Outpatient Psychotherapy Engagement (HOPE) Service. This service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help people who present with self‐harm‐related difficulties. The primary aim of this service evaluation was to ascertain the feasibility of HOPE in terms of attendance rates. The study also examined variables associated with engagement, and change over time in psychological distress for those attending the service. Method The HOPE service was evaluated over a ten‐month period. Consenting patients completed measures of psychological distress and working alliance across four therapy sessions and one follow‐up session. Measures of emotion regulation style and self‐harm function were also completed at the point of referral. Results Eight‐nine patients were referred to the service (83 eligible referrals). Fifty‐three (64%) attended at least one therapy session. Baseline variables did not distinguish people who attended and people who did not. Psychological distress decreased significantly across the sessions. Most people reported a good working alliance with their therapist. Conclusions The results of this service evaluation support the feasibility of the HOPE service, demonstrating good engagement rates given the complexity of the population and context. Whilst there was evidence of reductions in distress, randomized controlled trials are needed to determine if HOPE has clinical efficacy. Practitioner points Rates of engagement with HOPE suggest the service is feasible in an Emergency Department context Working alliance scores were positive for the majority of patients The HOPE service shows promise as a brief intervention for people who self‐harm but requires further evaluation Randomized controlled trials are needed to determine the clinical efficacy of the HOPE service

Reformulating the relationship between cognitive analytic therapy and research: Navigating the landscape and exploring new directions

“…Research into CAT so far provides evidence for the feasibility, acceptability, and safety of this approach across a variety of settings, populations, and modalities (Chanen et al ., 2008; Evans, Kellett, Heyland, Hall, & Majid, 2017; Gleeson et al ., 2012; Hallam et al ., 2020; Taylor, Fien, et al, 2020; Taylor et al ., 2018). Where research is currently less clear is with regard to the efficacy of CAT.…”

“…PBE also has the advantage that it better reflects real‐world practice, may better recognize individual context, and foster swift translation and implementation, which can be limited for more tightly controlled research trials (Warner & Spandler, 2012). Within this special issue, there are examples of PBE providing preliminary support for the acceptability of group CAT for anxiety and depression (Martin, Byrne, Connon, & Power, 2020), and for a hybrid CAT‐informed therapy for people who attend Emergency Departments following self‐harm (Taylor, Fien, et al, 2020). There is also an example of a more complex single‐case design (Kellett, Gausden, & Gaskell, 2020), demonstrating how practice‐based studies can provide in‐depth quantitative assessment of change in individual cases.…”

“…A common theme is that research into CAT has tended to focus on what could be considered more severe or complex mental health difficulties, including psychosis, personality disorder, and trans‐diagnostic difficulties like self‐harm (Calvert & Kellett, 2014; Hallam et al ., 2020; Taylor, Fien, et al, 2020). This focus may reflect the nature of CAT as a therapeutic model that works well with complexity and is able to adapt to the individual needs of each client, drawing on principles rather than be guided by diagnostic frameworks or protocols (Ryle & Kerr, 2020).…”

Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS): A Feasibility Trial Protocol

“…Previous evaluation of this therapy approach within ED settings found that 64% of referred individuals attended at least one therapy session, with nearly half (n=26, 49%) attending all four sessions. 29 There was also evidence of a reduction in distress over the therapy period.…”

“…COPESS is a modi ed version of psychodynamic -interpersonal therapy (PIT) which has previously been evaluated in two randomised trials for self-harm 26 and has also been used in NHS self-harm services in England. 29 PIT has undergone two modi cations for the purposes of this trial. Elements of another closely linked therapy, Cognitive Analytic Therapy (CAT), 30 have been added to the intervention with the use of visual mapping and a focus on identifying "exits" or solutions to clients' di culties.…”